Baby Love

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BABY LOVE

Robin Barker

v1.1
‘There are [more than] 874 babycare books available in Australia, so why do most of us
choose Robin Barker’s Baby Love?’
—The Age

Recommended by Choice Magazine

First published in 1994, Australia’s no. 1 babycare book, Baby Love, has since helped millions of
parents navigate life with their newborn. Xoum’s revised and updated digital edition features:

New full-colour illustrations

Handy search functions and useful links

Up-to-date advice and options to help with baby sleep and baby crying

Accurate information and reassuring suggestions for getting breastfeeding right for you

The latest on all aspects of your baby’s nutrition, including bottle feeding

A selection of healthy recipes to tempt even the fussiest eaters

Full of Robin Barker’s trademark wisdom and humour, this classic babycare bible also contains
valuable and important information about food allergies and intolerance, safe sleeping and
immunisation.

Authoritative, down-to-earth, essential reading for every new parent, Baby Love is the only
book you’ll need to help you through your baby’s first year.
Note to readers
All care has been taken to provide accurate, safe information, but it is
impossible to cover every situation, so please consult a competent health
professional whenever you are in doubt about your baby’s health or
behaviour. A book can never be a substitute for an individual professional
consultation. The author and the publisher cannot accept legal
responsibility for any problems arising out of the contents of this book.
For Babe, Adam, Kate, Kim, Sage and Jimmy …
In this book the mother is she, the father is he and the baby is she… (for no
particular reason).
Table of contents
Title page

Baby Love

Note to readers

Table of contents

Introduction

Part I: Birth–3 Months

1. Preparing for Parenthood

2. More Than One Baby

3. Premature and Small Babies

4. Doing it Alone—Single Parents

5. Choosing Baby Products

6. Breastfeeding—The First Two Weeks

7. Bottle Feeding—The First Two Weeks

8. Breastfeeding—After the First Two Weeks

9. Bottle Feeding—After the First Two Weeks

10. Early Worries and Queries

11. Daily Care

12. Safety

13. Growth and Development

14. Sleeping and Waking—The First Six Months

15. The Crying Baby

16. For Parents

Part II: 3–6 Months

17. Equipment

18. Feeding Your Baby

19. Common Worries and Queries

20. Growth and Development


21. Safety

22. For Parents

Part III: 6–9 Months

23. Equipment

24. Feeding Your Baby

25. Common Worries and Queries

26. Growth and Development

27. Safety

28. Sleeping and Waking—Six Months and Beyond

Part IV: 9–12 Months

29. Feeding Your Baby

30. Growth and Development

31. Safety

32. Becoming a Toddler

Recipes

What’s it all about?

Resources

Acknowledgements

Search terms

About the author

Other books by Robin Barker

Copyright information
Introduction
Baby Love is the result of the many years I have spent talking to women
about their babies. For twenty-five years my job as a child and family
health nurse was to help them by providing the technical knowledge they
needed to do the job, as well as to help them sort out the vast range of
ideas about babycare that drives modern parents mad.

All parenting information reflects the background, the qualifications and


the professional experience of the person providing it. Baby Love reflects
mine. Child and family health nursing is a broad rather than specialised
practice. The practitioner is there to see and help all-comers—mothers
who breastfeed and those who wean; parents who wish to co-sleep and
those who don’t; parents who wish to ‘wear’ their babies twenty-four
hours a day and those who don’t; parents who use childcare and those who
don’t; mothers who wish to breastfeed for years and mothers who wish to
wean at twelve months; parents for whom routine is important and parents
for whom it is not; parents who found it all easy, parents who found it all
difficult, and so on. Then there are the babies. Some sleep well, some
don’t; some feed well, others are pernickety; some love food, others turn
up their noses; some adore tummy-time, others hate it, and so on. The only
sane and ethical approach in such a practice was one of providing safe,
flexible options to suit the realities of the events and lives of the parents as
often as possible. I never saw it as my job to persuade or dissuade parents
from following particular child-raising philosophies or methods (unless
they were risky or dangerous) especially when in doing so I was likely to
further increase their confusion and, sometimes, their distress. Baby Love
follows this approach.

Baby Love is not meant to be read from cover to cover like a novel (heaven
forbid!). It is structured in the manner in which I worked so it is easy to
find the information you need at the time you need it by going to the age-
related parts or using the in-built search functions. As it is intended to be a
parent’s working manual, some information is repeated when relevant.
References to related subject matter are listed at the end of each chapter to
help you find more information on the topic when you need to.
Baby Love contains breastfeeding information that covers the whole of the
first year. The information is set in the context of the baby’s age and
development, bearing in mind the extensive range of baby behaviour and
the varying lifestyles of women and their families today.

The biggest concerns of parents in the first year after feeding are sleeping,
settling and baby crying. Baby Love looks at all these topics in a detailed,
structured way providing answers when there are answers and options
when there aren’t. Often just knowing that even the ‘experts’ don’t know
and that a particular worry falls into the normal range of baby behaviour is
a relief.

Group childcare for the under twos is a dilemma for many families. I think
there is ample evidence to suggest that group-style long daycare does not
provide the optimum quality of life for most babies and toddlers. It is
unfair to those parents who have a choice to keep giving bland
reassurances about the childcare options that are available; they need to be
fully informed in order to make the best decisions about paid work and
non-parental care that is available to them.

I recognise that options for many families are limited as they try to work
out how they are going to meet the needs of their children, the economic
needs of the family and their own personal needs and it is certainly not my
intention to make parents feel guilty. However, it is only by raising
everyone’s awareness that things on the childcare front are far from rosy
that governments and employers might seriously start to consider options
other than group-style long daycare for employed parents with babies and
toddlers.

At the time of preparing this revised digital edition (2013) there is much
discussion about government subsidised nannies and a parental leave
scheme which pays one parent (usually the mother) her normal salary for
her to stay home for the first six months. Improved wages and carer to
baby/toddler ratios, as well as mandatory educational requirements for all
childcare workers, have increased the costs of care for parents.

After years of talking to parents I know that most people approach


parenthood seriously and professionally and count on the health
professionals they seek advice from to provide them with accurate,
practical, safe information suited to their baby and their lifestyle. Baby
Love is written with this in mind as the start of your baby’s life unfolds.
Part I:
Birth–3 Months
Chapters:
1. Preparing for Parenthood

2. More Than One Baby

3. Premature and Small Babies

4. Doing it Alone—Single Parents

5. Choosing Baby Products

6. Breastfeeding—The First Two Weeks

7. Bottle Feeding—The First Two Weeks

8. Breastfeeding—After the First Two Weeks

9. Bottle Feeding—After the First Two Weeks

10. Early Worries and Queries

11. Daily Care

12. Safety

13. Growth and Development

14. Sleeping and Waking—The First Six Months

15.The Crying Baby

16. For Parents

{ Return to Table of contents }


1

Preparing for Parenthood


Part I | Contents | Next chapter
Babycare information is everywhere. Around the globe there are thousands
of books that cover the same information as Baby Love. ‘Parenting’
magazines and classes flourish yet, the most common phrase heard from
new parents, especially new mothers, is still, ‘Why didn’t anyone tell me it
would be like this?’

Despite all the information available, new parents are often left with the
feeling that during pregnancy some information was overlooked—even
withheld—that could have made a huge difference to their new baby
experiences.

How’s that for an encouraging start to one of the major events of your life?
Please read on—the nice bits are coming.

After years of working with families and babies I am convinced that there
is no way to totally prepare anyone for the incredible event of the birth of
their baby and what follows. An element of mystery remains, which is
impossible to anticipate or provide for. No two babies are alike; no two
mothers or fathers are alike. This is why, despite the avalanche of
information available covering the whole spectrum of babycare from
‘attachment-style babycare—never put your baby down’ to ‘strict routine-
style babycare—never pick your baby up’, no one can tell you what it will
really be like for you.

Mothers and fathers and parents


I have not followed the trend to exclusively use the word ‘parent’ rather
than ‘mother’ throughout Baby Love. The change from ‘mother’ to
‘parent’ in babycare books during the last decade as a way of recognising
that babies have fathers as well as mothers is very much welcomed,
however, the hopeful suggestion implicit in the use of ‘parent’—that the
work and lifestyle changes related to having babies are now equally shared
between men and women—is not the reality for many couples. Surveys
consistently show that in 80 per cent of homes the lion’s share of the
babycare and household administration is still done by women, regardless
of whether they are in paid work or not.

For this reason Baby Love is often addressed to women, as when children
are babies and toddlers the mother and father roles are not interchangeable
in the majority of families, so I hope fathers will forgive me for not always
referring to them specifically. The information is, however, set in a context
which regards their participation as absolutely essential.

Baby Love is also intended for same-sex couples. Regardless of their


situation, the ideal of a stable and functional family life is something most
parents strive for and I believe that it is possible to give children quality
care, love and protection in a variety of family structures. I acknowledge
that there are tougher challenges for same-sex parents and their children,
however, as the majority of same-sex parents in Australia are women, one
of the bonuses for them is that the care of their babies and toddlers is more
likely to be evenly shared.

Babies
Babies bring indescribable joy. They are funny, they make you laugh.
Having a baby makes you feel like you’ve joined the human race (although
during the blurry first year there may be times where you’ll feel as if
you’ve temporarily left it). It opens up avenues of communication with a
new group of people, some of whom you will go on to have lifelong
connections with. Caring for your baby and watching her grow brings a
great sense of achievement and is one of the most creative things most of
us ever do. Babies help you appreciate small things (like a good night’s
sleep). Babies change your priorities in life, develop your tolerance and
have the capacity to bring two people closer by sharing an exceptional
experience. Caring for a baby is fulfilling, rewarding and exciting. A baby
brings unconditional love which motivates you in ways you never thought
possible. Babies give us all a reason for living and hope for the future.

Before meeting your baby it is impossible to know how profound the


feeling of love is and how intense the anxious feelings about your baby’s
survival and wellbeing can be.

The hidden surprises about life with a baby are usually centred around
unexpected difficulties with babycare and feeding, lack of sleep,
unrealistic expectations of the time and attention babies need, and the
overwhelming conflict of emotions that are often very hard to deal with
and quite unexpected.
I often ask parents to tell me the positives and negatives of life with a
baby. Most parents find it much easier to talk about the negatives rather
than the positives, even though most find the whole experience
overwhelmingly positive. This book, in order to be of assistance, is full of
information about the negatives—crying babies, sore nipples, sleep
problems, relationship difficulties, stress, fatigue, anger, depression, crying
mothers … is this what babies are all about? How come everyone wants
one? Does anyone have a nice time with their baby?

The answer is ‘yes’, but the positive aspects are harder for many parents to
express, identify and enjoy when they are trying to adjust to a completely
new lifestyle that may place more physical and emotional demands on
them than they ever felt possible. And a book like this has to cover the
wide range of things parents may experience—including the possible
difficulties—so they can get help or reassurance if they need it.

Certainly it’s easy to get bogged down by the sleepless nights, the messy
moments and the chaos and disorganisation that babies bring, but if life
with babies meant only this the human race would have died out.
Becoming a parent means learning how to savour and share the joys as
well as the stresses and strains. The best thing anyone can do for another
human is to be a true-blue, loving parent; the benefits flow on for
generations.

Part of preparing for life with a baby is about realising and accepting the
element of surprise and the unknown, but there are plenty of practical
things you can do beforehand which will help you manage when things
don’t go according to plan.

Here are some suggestions:

Attend childbirth education classes


Most of these classes are primarily concerned with the birth, however there
are also many other advantages in attending. Classes put you in touch with
other people who are sharing the same experience. The classes are
excellent resource centres which will give you a few clues as to what help
is available in your local community after your baby is born. You will also
be taught relaxation skills that may prove invaluable long after the actual
birth.
Classes are held in maternity hospitals, some child and family health
centres, some family care centres and by private organisations, some
online. Courses run by government bodies charge a token fee, those run by
private organisations charge more.

Is there a parentcraft class near you?


Unfortunately these are few and far between—possibly because it’s hard to
convince prospective parents that they are very helpful, and people who try
to run them give up when no one turns up. Parentcraft classes concentrate
on the practical aspects of babycare such as bathing, dressing, nappy
changing, equipment to buy, breastfeeding, crying and common worries
and queries about the early weeks. Many maternity hospitals, family care
centres and child and family health centres run groups for new mothers
after the birth. Some of the topics are also very helpful for prospective
parents, so going along before the birth, listening to the talk and mixing
with new parents can be useful.

Alternatively, if classes and groups aren’t your scene, you can select
something from the mountain of DVDs, magazines, books and internet
sites dealing with birth and parentcraft.

Borrow a baby!
Your baby will be blissfully unaware of your inexperience as a parent, but
if you have a few babycare skills it can make the first few weeks more
enjoyable. Being able to change a nappy, dress and undress a baby, and
wrap and handle a baby with confidence will help you feel less nervous.

Of course, it’s not always possible to find a baby to practise on. If your
friends don’t have babies and you feel very unsure of your skills, think
about booking into a family care centre after birth. Family care centres are
government subsidised places which offer help to mothers and babies.
They have a pleasant, homelike atmosphere with an option of spending the
day or staying overnight until you feel more confident about caring for
your baby.

Family care centres are found in capital cities and larger rural regional
towns. Some centres will take mothers and babies soon after birth, others
have a waiting time of a week or two. At the time of writing the cost is
covered by Medicare.

Never feel inadequate or silly because you need to learn basic babycare
skills. Babycare skills don’t come naturally to most people—men or
women—and usually have to be learnt.

Plan to live with fatigue


Extreme tiredness—both physical and emotional—is the most common
problem in the first few months. It’s worth taking the time to discuss with
your partner what you both imagine will happen after the birth.

Speculate out loud (even if it feels strange).

What will it be like when the baby cries in the middle of the night?

What do we do when she cries incessantly and we can’t sleep?

Who will stay up with the baby?

As the father, will you change nappies, do the shopping, cook


sometimes?

As the mother, will you tell your partner when you want him to do
something? This is new to him too and he is not sure what is expected
of him.

As the father, how much time are you able to spend with the baby?

As the mother, what will you do when you are exhausted, the baby
won’t stop crying, there’s nothing for dinner and there are no clean
clothes to wear? Who can you turn to for help?

Talking about these things with your partner may seem trivial and
unnecessary, negative even, but imagining the reality together and
discussing all possibilities means you will both learn to manage the
changes much better.

Here are a few practical things you can do in advance:


Get as much rest as you can before your baby arrives. If possible, do
not continue your paid work until the first contractions—give yourself a
few weeks of self-indulgence.

Stay healthy by eating properly and exercising—this sounds boring and


predictable but makes a great positive difference to your energy and
stress levels.

If you are an active superwoman, afternoon naps probably aren’t your


style but prepare yourself mentally for daytime sleeping after the birth
as a stint of night duty is almost always unavoidable. Changing your
sleep patterns for a short time is easier than changing your baby’s as
there is no safe way of making young babies sleep through the
night.

Learn about breastfeeding. Breastfeeding is covered in detail in the


baby feeding sections of this book. Breastfeeding is not always easy to
begin with and the more you and your partner know and understand, the
easier it is.

Give yourself as much room to move as possible. If your life is run on a


tight string everything takes on a nightmarish quality the minute the
smallest thing goes wrong. Babies are unpredictable; they need time
and peace to adjust to their new world and some need more time and
peace than others.

Avoid moving house and major renovations when your baby is very
young. Overseas visitors who arrive at the same time as the baby and
stay for months create a great deal of stress. Women often agree to
things like this in order to show they are managing well, but it is most
unfair of those around her to assume arrangements like this are all right.
Make sure relatives invited to help are the people she wants.

Any major lifestyle change is harder when you have a new baby; for
example, your partner changing jobs, starting a new business
(especially if you’re the one doing the books as well as caring for the
baby and doing the housework!) and overseas trips. These things are
often unavoidable, but if you talk about them before the birth,
alternative plans or compromises can sometimes be made.

Mad shopping expeditions after your baby is born are exhausting. Plan
your clothing, bedding and equipment carefully and have it ready and
waiting.

Women are frequently told to ‘forget the housework’, yet more often
than not the expectation persists that the mother will keep everything on
the home front ticking over as well as taking care of the baby, even
when she is utterly sleep deprived. Furthermore, many women find that
living in a shambles increases their stress rather than the reverse and if
they don’t attend to the household chores no one else does. Ideally,
some sort of system should be worked out in advance. Don’t be shy
about asking for help. Is your partner prepared to share the housework
more evenly? Can your mother or partner’s mother help? Is there a
possibility of paying someone to do some cleaning for the first few
months?

Going back to your other job raises many important issues which are
discussed in detail in chapter 16, so before you make any firm decisions
please read this section carefully. It is vital to give serious thought to
the pluses and minuses for babies and toddlers in care under the age of
two so you are not locked into a decision you may regret.

If returning to paid work is unavoidable in the first year, try to limit the
hours your baby spends in group care settings (e.g., long day care,
family day care) by choosing part-time work or sharing care with your
partner or a trusted close relative.

If you are planning to use childcare in the first six months, you will
need to allow plenty of time to work your way around choice and
availability as well as through the tangle of government childcare
funding and fee-relief schemes, which seem to change on an annual
basis. When you have figured it all out and made a decision, book your
baby in as soon as possible as, usually, there are only limited places in
the first year in most group childcare settings. In fact, in order to get a
place in the first year it is advisable to make bookings before your baby
is born.

Childcare fees for centre-group care range from $65.00 to $140.00 a


day depending on the number of hours, what is provided, the age of the
baby/toddler/child, and who is running the centre.

Family Day Care, a scheme where caregivers mind children in the


caregivers’ homes co-ordinated by local councils has a similar range of
fees as above.

Nanny fees range from $20.00 to $35.00 an hour, about $200.00 a day.

At the time of writing (2013) there is much discussion about


introducing government subsidised nannies, and a new generously
means-tested parental leave scheme which pays one parent (usually the
mother) her normal salary for her to stay home for the first six months.
And improved staff wages and carer to baby/toddler ratios as well as
the introduction of mandatory educational requirements for all childcare
workers have increased the costs of care for parents.

Government Childcare Provisions 2013


Because of the rapidly changing (and increasingly complicated)
governmental childcare provisions, here is a list of what is potentially
available in 2013.

All the following benefits are means-tested and eligibility conditions


apply; it is not possible to receive both the Baby Bonus and Parental Leave
Pay.

Parental Leave Pay


Subject to the passage of legislation, from 2013 the Parental Leave
Scheme will be expanded to include Dad and Partner pay, again
subject to a means test and eligibility criteria

Baby Bonus

Family Tax Benefit

Parenting Payment

For More Information


I strongly recommend you go to the Department of Human Services
website www.humanservices.gov.au families where all will be revealed

Alternatively, call 13 61 50 between 8 am and 8 pm (local time)


Monday to Friday

Visit a Family Assistance Office located in Centrelink or Medicare


Offices

CareforKids is a privately run childcare resource that aims to help


parents through the complexities of the system. The company also
publishes a childcare reference book. Go to www.CareforKids.com.au
or call (02) 9235 2807

Knowing how to relax


You are likely to become very irritated at the number of times well-
meaning people (usually health professionals) tell you to ‘just relax’ when
you are in situations not at all conducive to relaxing. Knowing how to
relax is an art, especially when the going gets tough. It’s useful to learn
about and practise a few relaxation techniques when you are in a calm
frame of mind so you can draw on them when things get tense.

Here is a very simple way to help you relax in a tense moment.

Whenever you feel stressed or uptight, take a few minutes to regain


control.

Stop whatever you are doing, making sure your baby is safe.

Clench your fists and close your eyes, taking in a deep breath.

Breathe in slowly through your nose … and breathe out very slowly
through your mouth.

As you breathe in, tighten your fists while keeping your eyes closed. As
you breathe out, open your fists.

Shake your arms gently. If you are standing, give your legs a shake at
the same time.

Drop your shoulders and take a few more deep breaths, relaxing your
neck, shoulders, chest and abdomen.
Tell yourself that you will remain calm—that it is all okay.

For fathers

Being a father is obviously very different from being a mother. Working


out precisely why is a little more difficult.

The mother has already started a relationship with the baby during
pregnancy and her new work in caring for the baby is quite
straightforward. On the other hand, the father—unless he is one of the
small number who plan to stay at home with the baby or equally share the
work and care—can, outside of his paid work, do as little or as much as he
chooses and his role in relation to the baby is not straightforward at all.
The father has to build a relationship with his baby and keep one going
with his partner. Lots of men find that this is a strange experience for
which there are no clear and precise guidelines. Unless a man has some
previous hands-on experience with a baby, he is unlikely to know what to
do with one of his own.

A great opportunity
Many men do now have a more hands-on presence in their children’s lives,
either from choice or necessity or a little bit of both. The benefits of this,
both for the children and the community, are incalculable. But,
understandably, many men feel there is no recognition of the fact that the
provider role is still mostly theirs. They have to single-handedly take care
of the mortgage and can feel locked into an inflexible work role from
which there is no escape. This is changing to some degree however the
number of families where the paid work and home work are evenly shared
remain small.

Very often, after the euphoria of the birth fades, the mother disappears into
the mother world and the father disappears into the father world with a
general lack of understanding from both about each other’s worlds. This
seems to happen to many couples despite the best-laid intentions
beforehand to ‘share the load’, so the housework and babycare ends up
belonging to the woman while the man dedicates himself to paid work.
Women often feel disappointed, tired and alone, while men are often
concerned about money, feel they have no leisure time and that life is no
longer any fun.

Is this unavoidable? Yes, to some extent, depending on how much the


couple want to avoid it. Often, fathers don’t know what to do or how to
change the way things are and many mothers don’t know how to separate
from their babies and include their partners in their new lives. These are
probably the main reasons most relationships go through a difficult patch
during the first six months after a baby arrives.

When you’re a new father, chances are you’ll need some information and
ideas to help you become a family man instead of the distant, non-
participating breadwinner. Granted, there will be times when the latter role
is more attractive and indeed a handy escape from the daily humdrum of
domestic life, but the men who become hands-on fathers discover a
profound dimension to their lives, difficult to describe but never to be
missed. Many men over fifty express disappointment about not having
helped more and not having spent more time with their children
throughout their lives, especially when the children were babies. Older
men who become fathers the second time around frequently become
participating fathers the way they never were the first time.

Don’t let the opportunity pass you by!

Some inside information


In general
The last thing I want to do is alienate fathers, especially the ones who do
share the care, but I think it’s important to let you all know that surveys
still show most blokes don’t do enough during the labour-intensive,
sometimes boring, sometimes tedious first few years. To put it bluntly,
selective help is not enough—cooking the odd meal, changing the
occasional nappy, playing in the bath with the baby or toddler or reading a
story before bed are all relatively enjoyable tasks which don’t contribute in
any sustained way to the nitty-gritty, down-on-your-knees care of babies
and toddlers in the first three years. The only way to get some equity is to
draw up a detailed list of jobs, make a roster and stick to it, regardless of
whether your partner is in paid work. It’s vital during evenings, at
weekends and during holidays that the care is shared and both partners,
rather than just one, have some reliable time off (more than an hour here
and there) to pursue sport or some other activity. Inadequate help during
these years leaves many women with a wafting thread of resentment that
never quite fades and has the potential to detract from otherwise solid
relationships.

After the birth


Help your partner have a peaceful, pressure-free home after the birth,
free of unwanted visitors and relatives.

Try not to have unrealistic ideas about your baby. She will amaze and
delight you, but she will also cry, throw up, poo everywhere and disrupt
your life. Your partner will not instinctively know what to do a lot of
the time, so don’t expect this or make her feel she should know. On the
other hand, she might know. Either way, if you can gain some
understanding of normal baby behaviour and give some practical help
rather than advice, you will be doing a lot to support her.

Accept change. Pretending life will go on as before means the changes


will be for the worse, not the better. A lot of the changes are temporary
but some are permanent, and to keep on waiting for things to get back
to ‘normal’ creates friction and makes the time with your baby much
less satisfying. What is ‘normal’ in your life with a baby is not at all
what normal used to be.

Some of the temporary changes are things like less or no social life and
maybe less or no sex for a while. Babies are very good at creating chaos
in the evenings, so being prepared to come home and take over until
this stage has passed will mean an enormous amount to your partner.

It’s important for your baby to have lots of physical contact with you as
well as her mother. Dressing and undressing her, changing her nappy,
bathing, cuddling and playing with her is a great way to get to know her
and for her to get to know you. Don’t worry if she cries in the early
weeks whenever you do anything with her—this stage is only
temporary and passes quickly. Lying with her on your bare chest and
stroking her back will help calm her and you will both enjoy the skin-
to-skin contact. Carrying her in a front-pack at home, or when you are
out and about, and bathing and showering together are other ways of
enjoying each other.

Sleep deprivation is always an issue. Many parents, and fathers in


particular, tend to think there is some way very young babies can have
their sleeping and crying patterns changed so adults are able to sleep the
way they did before the baby arrived. This is not possible and as no
one, father or mother, can exist indefinitely on little or no sleep, co-
operation and planning will make living with broken sleep easier until
the baby is older.

For example, if your baby is waking a lot at night, your partner will be
under a lot more stress if you constantly complain about your lack of
sleep. She then feels she is dealing with two babies, not one (or three if
you have twins). Talk things over. It may work better if you sleep in
another room on some nights so you can remain lucid at work the next
day. At the weekend you can help by bringing your baby to your
partner for a breastfeed, or feeding her yourself if she’s bottle fed, and
then taking the responsibility to settle her after the feed (which might
mean walking the floor if she’s not ready to sleep).

When your partner is up a lot at night she will need to rest when the
baby sleeps during the day, which means you may come home to no
dinner at times. If you are prepared for this and for sharing the
household tasks more evenly, especially the shopping and the cooking,
your family life will be much more harmonious.

The first few months after giving birth is a very teary, emotional time
for many women. While that great scapegoat, ‘hormone imbalance’,
possibly contributes to a minor degree, many other reasons exist for
these erratic feelings and these mainly centre around the shock of
motherhood. The shock of motherhood affects every woman’s self and
lifestyle and is a mixture of a sense of gain, a sense of loss, intense joy,
intense fatigue, intense worry of the sort never felt before (which fades
but never quite goes), boredom, wonder, delight and lingering fears that
the former body she once occupied has gone, never to return. You don’t
have to find solutions—listen, comfort and give her practical help.

The shock of fatherhood means you will feel some of these things too,
as well as other feelings particularly related to fatherhood—like a
mixture of jealousy towards and overwhelming feelings of love for your
baby. A sense of losing an exclusive relationship with your partner as
well as enormous respect for her for enduring the mystery and pain of
childbirth, plus confusion about re-establishing a sexual liaison with a
woman who is now a mother are all strange new feelings you might
experience. It’s much better to acknowledge these feelings and talk
about them with your partner rather than burying them or letting them
simmer.

Give your partner some time to herself whenever you can. Take your
baby for some long walks—don’t come back in ten minutes. Offer to
care for your baby while she has some time out with friends or goes to
the hairdresser. If you can come to reliable arrangements about timeout
without constantly having to be reminded, she will have something to
look forward to and plan for each week, even if it’s only a couple of
hours. Don’t worry—healthy breastfed babies who won’t take bottles
can last two to three hours without a breastfeed.

Last but not least, support your partner’s care of your baby. Many
options are possible when caring for babies, which gets a bit confusing
at times. A co-operative approach works best, so help and encourage
her decisions.

Breastfeeding, for example, is much better when those around the


mother have a basic knowledge of how it works and show confidence in
the mother and baby’s ability to breastfeed.

Finally
Having a baby is one of the most wonderful events in life. The next twelve
months are the beginning of an extraordinary adventure and you will find
it is a moving, loving, fearful, exciting, boring and muddling time. You
probably don’t think you know much or you might think you know
everything—either way you’re likely to be surprised by the extent of your
ignorance or knowledge.

In the past the extended family provided a lot of help and information and,
in many families, still does. The advice of years gone by was by today’s
standards often rigid, but it supplied consistency and structure, unlike
today, where the plethora of baby and childcare information provides an
endless supply of conflicting advice.

The sweeping lifestyle changes over the past fifty years have not only
given new parents more independence and freedom, but more uncertainty
and soul-searching about what they should and shouldn’t do.

Being a parent is not always easy and is certainly not simple, but when
sifting through the maze of information it’s important to remember that
babies’ and children’s basic needs have never changed. They need
buckets of love, the right food, a safe place to grow, lots of cuddles, the
chance to learn the skills they need to take their place in the world and
constant interest in their progress through life from the same one or
two adults in a peaceful home.

It’s possible to give your baby all this in your own way according to your
own particular beliefs, culture and lifestyle. Safe options are usually
available—the trick is working out the best plan for you and your baby and
not getting too bogged down by preconceived ideas or completely
impractical theories which sound great ‘pre’ baby but fall apart in the
realities of life after birth.

FOR MORE INFORMATION


Chapter 6: Breastfeeding Your Baby For the First Two Weeks

Chapter 16: For Parents (childcare/returning to paid work)

FURTHER READING
From Here to Paternity: A User’s Manual for Early Fatherhood, Sacha Molitorisz, Pan
Macmillan Australia, 2008. I am aware that many fathers feel left out at times, particularly during
the birth and what comes after. Father books were once unheard of but in the last decade they’ve
begun to creep onto the market. If you are looking for a father book for the roller-coaster first few
months this is the one I recommend. It is hip, honest and from the heart, and provides a host of
things new fathers wonder about in a straightforward, engaging way.
2

More Than One Baby


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Twins occur in about one in sixty births. Exactly why multiple births occur
is something of a mystery but it is more likely if there is a strong family
history or, in recent times, because more women are delaying conception,
taking infertility drugs or turning to in-vitro fertilisation (IVF). Women
who conceive between the ages of thirty-four and thirty-nine are more
likely to give birth to twins.

Twins may be identical (monozygotic) or fraternal (dizygotic). Identical


twins occur when one egg and one sperm join and then split into two
halves. Each half has identical genetic make-up and both halves are
usually joined to a single placenta by two cords. Identical twins are the
same sex and look very similar.

Fraternal twins are more common. They come from two separate eggs
being released instead of one. Each egg is fertilised by a different sperm so
there are two placentas and two cords. Non-identical twins are just as
different to look at as any two children of different ages with the same
parents.

It’s more common for women over thirty-five to release two separate eggs
at the same time when they ovulate so non-identical twins are more
common when the mother is older.

It’s rare for twins to arrive unannounced these days—most are diagnosed
well ahead of time. A twin pregnancy is like a single pregnancy but with
both the delights and discomforts somewhat magnified. Women having
twins need plenty of rest—and this is often difficult when there’s another
toddler in the house. A premature birth is more likely, as are minor
complications, which means one or both babies might need special care for
some time after birth.

Knowing twins are on the way evokes a joy difficult to describe and most
parents with twins are irritated and annoyed by the generally negative
comments which are commonly expressed by people who only have one at
a time. It is certainly a surprise, but the initial feelings of shock are quickly
replaced by feelings of excitement and delight with the anticipation of the
arrival of two little people.

Like having one baby, there are negative aspects about having twins.
These are perhaps most noticeable during the first year, but parents of
twins find the rewards and sense of achievement for ‘twice the work’ give
‘twice the pleasure’. Here are some thoughts from parents of twins:

It’s a great ego trip to have two beautiful, healthy babies.

Two babies keep each other entertained, especially when they’re in the
bath together. I love watching the two of them—it makes me melt inside.

There’s an enormous feeling of accomplishment and pride watching


them grow. The pleasure of seeing two of them smile and talk and
having two of them hug you is indescribable.

Twins attract an enormous amount of attention, which can be a


nuisance, but also makes you feel very special and part of an exclusive
club.

My girls are a joy that is impossible to describe—it starts at the toes


and works its way right up to my heart.

If you are having twins it’s a good idea to get in touch with friends who
have twins and the Australian Multiple Birth Association for clues on what
to buy as well as some enlightened information and reassurance. Few
health professionals have any personal experience to offer in the realm of
day-to-day management of twins.

Everyone chooses slightly different equipment and everyone ends up


managing in their own way, so it’s important to be flexible. You may feed
simultaneously, you may feed separately. Options for prams include the
traditional pram (difficult to get through doors), tandem style (where the
babies sit one behind the other), or the side by side lightweight stroller,
which is the choice of most parents. Some of your equipment and clothes
can be borrowed, hired or bought secondhand.

Obviously any useful help should be snapped up if offered voluntarily, or


paid for if you are financially able to do so.

While life with twins and triplets varies widely from family to family there
are some common difficulties during the first year. Here is a brief look at
three of the most common:
Breastfeeding
Most women start out with every intention of breastfeeding their twins and
triplets. While it can be a struggle for the first three months, as can
breastfeeding one baby, breastfeeding twins is certainly achievable and
often easier than bottle feeding if there are no overwhelming problems. If
you are reading this before your twins are born, learn all you can about
breastfeeding before the birth. If possible, visit someone who is
breastfeeding twins who can talk to you about the practicalities and show
you how she does it. An optimistic approach is to be encouraged; however,
bear in mind that a considerable number of women find the reality of
breastfeeding twins beyond them after the first six to eight weeks, even
with the best intentions and the right advice. It’s sensible to be prepared
for other outcomes so that you are not totally devastated if things don’t go
to plan. These may include using expressed breastmilk in bottles,
combining breast and formula feeding or fully formula feeding earlier than
you planned. Breastfeeding triplets requires some bottle feeding which
may be expressed milk or formula. Occasionally triplets receive mostly
breastmilk for extended periods, but most mothers of triplets find the
demands of such a strategy too hard to meet and use formula (with my
blessing).

Small differences
Remember that the normal variations in eating, sleeping, crying, behaviour
and development will occur with twins as they do with any two babies.

Sleep
Sleep information is the same for twins as singles, however, two babies
complicate matters when their sleep patterns vary. This is particularly
difficult in the first six months when it can be hard to get the babies
synchronised. ‘Yo-yo’ crying, where the babies take turns to cry and sleep,
means there are periods of the day and night where they never seem to be
asleep at the same time. This is often a problem around three to six
months. As usual there are no easy answers. It’s important to stay flexible.
Some parents find things work better by separating the babies for some
periods of the day and night, others find it useful to sleep them together.
Residential mother and baby centres can provide good respite care in the
first six months if needed.

And here in some parents’ own words are some of the difficulties of caring
for twins in the first year:

The first year is hectic. It’s easy to get completely bogged down by the
chores and miss the good bits—the playing, the laughter, the cuddles
and the amazing way they learn about the world.

It’s isolating because it’s very often hard to motivate yourself to go


anywhere; it’s such a hassle and so difficult doing simple things—like
catching a bus, getting up and down stairs, and so on. I now know how
disabled people feel.

It’s exhausting having two babies crying and wanting attention at the
same time. It’s essential to learn to tune out and deal with them one at a
time.

Two babies means two of everything and costs more.

The safety factor is more of a concern, especially when the babies


become more mobile. Keeping them safe is constant hard work and
exhausting at times. Long bouts of sickness are very difficult.

Triplets
Caring for triplets is an exaggerated version of caring for twins. Every
mother is a working mother, but a mother of twins or triplets works very
hard indeed. While much of Baby Love is as relevant to multiples as to
singles, I recommend the following book for brilliant inside information:
Twins by Katrina Bowman and Louise Ryan, Allen & Unwin, Australia,
2nd edition, 2010.
3

Premature and Small Babies


Previous chapter | Contents | Next chapter
A ‘small’ baby is one who weighs less than 2.5kg (5lb) at birth. Babies
may be born small because their parents are small, because they are born
before the expected forty weeks’ gestation or because they are born
smaller and frailer than would be expected for the number of weeks they
were in the womb.

A full-term ‘small’, healthy baby born to small parents does not need any
special care.

Babies born before thirty-seven weeks’ gestation are called premature


babies and may need help with some important body functions such as
breathing, eating, digesting and maintaining body temperature and sugar
levels. The earlier a premature baby arrives, the more help she is likely to
need.

The survival rate for premature babies is three times higher than what it
was in the early seventies. Because of improved technology and skilled
staff care the chance of a positive outcome for even very premature babies
has doubled in the last decade. Babies born up to eight weeks early have
about the same chance of survival and normal development as babies born
at full term. About one in every 130 babies born prematurely weighs less
than 1500 grams (3lb) at birth (the average birthweight for thirty weeks)
and with expert care 90 per cent of these babies grow up fit and healthy
and only about 5 per cent have major handicaps. Even babies born at
twenty-eight/twenty-nine weeks now have an 85 per cent chance of a fit
and healthy life although there’s often a long, hard haul in the beginning.

Premature babies needing specialised care have a much better chance


when they are cared for in the biggest and best centres and are transferred
to these centres when necessary by a special transport service with highly
trained teams giving intensive treatment along the way.

If you know in advance there is a possibility of a premature birth do an


intensive care nursery tour if one is available at the hospital where you
expect to give birth. Doing this can help prepare parents—but make sure
you have plenty of tissues and a sympathetic health professional with you.

‘Small for dates’ babies may be full-term or premature babies who have
not grown as much as they should have during the pregnancy, usually
because the placenta did not function efficiently during the last few weeks
before birth. A ‘small for dates’ baby needs extra attention as well—the
amount depends on the number of weeks she is at birth and how much she
weighs. Some babies can stay with their mothers where their breathing,
body temperature, heart rate and blood sugar levels are regularly checked
by midwives. Others may need to be in an incubator for a short time.

Healthy, full-term ‘small for dates’ babies usually have a good appetite,
suck well and put on weight appropriately in the first three months.

What causes prematurity and/or


‘small for dates’ babies?
About half are unexplained. Some women just seem to give birth a little
earlier. This may happen with all their pregnancies, so knowing an early
birth might happen can help the mother and her family prepare for the
event.

Medical problems such as an infection, kidney trouble, high blood


pressure, high blood pressure of pregnancy, or bleeding during the
pregnancy can contribute to an early birth and/or a small baby.

Waters break early (ruptured membranes).

The chances of an early birth and/or smaller babies are increased when
twins or triplets are expected.

Who is more likely to have premature


babies?
Teenagers having a baby for the first time.

Older women (over thirty-seven) having their first baby.

Smokers—10 per cent of all premature births can be attributed to


smoking and it is recognised that smoking during pregnancy also
contributes to babies being born ‘small for dates’.

Excessive alcohol or other drugs of addiction also contribute to giving


birth to small/premature babies.

When babies are very small, premature or sick, they need special care in a
neonatal intensive care unit.

The care is aimed at keeping the baby alive and well while her body
matures. Immaturity of heart and lungs, nervous and digestive systems as
well as problems with breathing and temperature control and the
possibility of infection require skilled one-to-one nursing combined with
highly sophisticated technology.

The atmosphere of a special care nursery can be daunting, but hospital


staff try hard now to care for families as well as babies. You will be
encouraged to spend as much time as possible with your baby, but if you
find everything completely overwhelming take it slowly until you feel
more comfortable about being in the nursery.

Ask lots of questions—write them down as you think of them no matter


how ‘silly’ or frightening they seem. Every parent wants to ask things like,
‘Will she live?’ or ‘Will she be normal?’ and ‘How long before we can
take her home?’

Feeding
If your baby is too premature to suck and digest food, she will be fed either
by a fine tube directly into the stomach or by a tiny direct drip into the
vein. The staff will show you how to express and store your milk which
can be used for your baby straight away or once she is able to tolerate milk
feeds depending on her condition.

You can participate in the care of your baby by changing her and tube
feeding with instructions from the staff as soon as you feel up to it. Many
mothers say the ‘out of control’ feeling is one of the hardest things to deal
with and caring for their babies while they are in the intensive care nursery
helps them feel more in control.
Feelings
As well as dealing with the practical issues, you might find yourself
overwhelmed by some unexpected emotions.

Feelings of numbness, of being out of control and in a dream-like state are


very common. Sadness, anxiety and guilt are also very powerful emotions
that parents feel when their baby has a problem after birth and those
feelings may make you angry with each other, the staff at the hospital and
even, perhaps, the baby. All these hurt feelings are part of the accepting
and healing process which will happen in time. Some parents benefit from
debriefing with a skilled counsellor.

You might find that people, even close friends, don’t congratulate you or
send the usual gifts and flowers, which can be distressing. Jealous feelings
towards other mothers with their full-term babies and pregnant women
obviously due soon are often felt by mothers of premature babies. Leaving
your baby behind when you go home is sad and very hard to come to terms
with, but nowadays every effort is made to get babies home as soon as
possible.

Going home
There isn’t likely to be a predetermined age or weight at which your baby
is allowed to go home. Various factors are considered, such as her general
condition and how well she is feeding and putting on weight. Some babies
are discharged quite early when there is a follow-up team from the hospital
who can visit the family at home. Babies may be discharged even though
they still need oxygen for lung problems.

Follow-up support varies throughout the country. Capital cities always


seem to have more resources and more help available for parents who have
sick and/or premature babies. Some major maternity hospitals continue to
give specialised care from staff who come to your home for a time. This is
a great help. Apart from this you can seek assistance from your
paediatrician, your family doctor, your child and family health nurse and
community nurse. And in the immediate weeks following your baby’s
departure you can continue to call the medical staff who can answer your
queries about her care.

Nervous feelings about taking your tiny baby out are normal for a while.
When you do take the plunge you will find everyone stops you to
comment on how small she is. One mother told me it made her feel as if
she never fed her baby.

Premature babies who are born healthy follow the same range of crying,
eating and sleeping patterns as healthy full-term babies.

Very low birthweight and sick premature babies may be erratic and tense
and can be a great challenge to care for until they become more settled and
predictable. Very low birthweight babies may also need extra care
throughout the first year for wheezing conditions and gastroenteritis.
Surgical repair of an inguinal hernia is also common.

Premature or sick babies benefit from a specific way of positioning and


handling and by avoiding the use of bouncers, walkers and doorway
jumping seats. Good help with this can be obtained from physiotherapists
and occupational therapists (see Further Reading at the end of this
chapter).

A premature baby has to spend the first weeks or months of life making up
for lost time in the womb, so naturally she’ll reach developmental
milestones later. By the time most premature babies reach their fourth
birthday, four out of five have caught up with their peers and many catch
up long before this, some in the first twelve to fifteen months.

While it’s wise to bear in mind your baby’s prematurity when assessing
development, it’s also a good idea to start to treat your baby normally as
soon as you can and encourage those around you to as well. All the
information in this book is as applicable for babies who have been
premature or sick as it is for any other baby. In areas where I think mothers
of premature babies need a little reassurance or extra information I have
included it.

FOR MORE INFORMATION


Chapter 8: Breastfeeding Your Baby After the First Two Weeks (expressing and storing
breastmilk)
Austprem is an incorporated, non-profit organisation in Australia available to help parents and
caregivers of premature babies and children. All those involved in Austprem have experienced or
been closely involved with the experience of prematurity. Go to www.austprem.org.au
4

Doing it Alone—Single Parents


Previous chapter | Contents | Next chapter
I’m sure one of the irritating things about being a single parent is the
constant assumption in pregnancy and baby information that there are
always two doing it. Pictures of mothers and babies in magazines and TV
series always depict smiling, happy, well-groomed mothers who invariably
have smiling, well-groomed, caring men sitting beside them. The reality is
that nearly a quarter of Australia’s parents live on their own with their
children and many more parents are on their own a great deal of the time
because of absent partners.

I am guilty myself of not mentioning single parents specifically throughout


this book, mainly because of the difficulties in constantly referring to the
total range of parenthood experiences. In my work I often talk to single
parents, who range in age from as young as fourteen to as old as forty-
eight. They are usually women, less often men. All of their stories and
reasons for being on their own are different. More women today are
choosing to be pregnant alone so they don’t miss the experience but for
most, single parenthood is not a choice but the consequence of unplanned
pregnancies or relationship problems.

The lovely things that babies bring are there for everyone whether they
have a partner or not, but not having anyone to share the physical and
emotional demands of babycare with makes the job harder. Thankfully our
society has largely moved away from the moral judgements and harsh
treatment of single mothers so prevalent for much of last century. There is
more help available today from government agencies and community
support networks than ever before.
A few tips just for you
Contact the Family Assistance Office on 13 61 50 to make sure you get
all the government assistance you are entitled to.

Try to arrange to have someone with you for the first three weeks or so
after the birth as this is usually a physically and emotionally draining
time (a weird combination of exhilaration, extreme fatigue, relief and
anxiety).

Make sure you know where to go or phone for help, for example, the
Australian Breastfeeding Association, the nearest children’s hospital,
the child and family health nurse, a mother and baby centre, a family
doctor, and so on. Put all the numbers into your mobile and/or have a
list by the landline.

Take up all offers of practical help. When it is offered give the helper
specific ways in which they can be of assistance.

It is of huge benefit for all parents to have access to a network of


reliable friends and family but this is particularly so for single parents.
If you don’t have this support it is crucial for you to establish contact
with other mothers, single or otherwise. Obviously having contact with
other single parents means you are spending time with people going
through the same experience as you but you’ll also find that you’ll have
a lot in common with all mothers so don’t limit your options here.
Mothers’ groups can be invaluable for this or you can find out via your
local council or community health centre what might be available for
you to tap into. Most local areas have a range of resources available for
mothers and babies.

Make staying sane and healthy a priority. It’s normal to feel


apprehensive about raising children, most of us do. This is one time
when you really do need to live one day at a time until you adjust to
your new life. Eat well, do some simple exercise and catch up on sleep
whenever you can.

Never lose sight of the fact that the main things babies and children
need are love and security which you can give in bucket loads. There
will be times when you find the going hard but very few women—or
men—regret having children.

You may need childcare during the first year for social and/or work
purposes. For short periods occasional childcare centres are available to
give you time off for shopping, dental appointments, study, social
events and many are approved for government subsidy of their fees. To
find out what’s available in relation to the whole spectrum of childcare
go to the links and resources in chapter 1.

As you emerge from the first year, start to make plans for an optimistic
future. Working for a qualification part-time or part-time work is a
great morale booster and will give you confidence and help you meet
new people. It’s a good way to move back into the wide world again.

For a summary of resources for single parents try www.fahcsia.gov.au


or call 1300 653 227.
5

Choosing Baby Products


Previous chapter | Contents | Next chapter
Part of the excitement of preparing for your baby is deciding what clothes
and equipment to buy and this chapter is to help you buy the things you
need before your baby arrives. The range of products is endless and it’s
often hard to sort out useful and essential items from those that are merely
decorative or simply duds. Buying for babies is flavoured with emotion.
It’s easy to get carried away gazing at a quaint cradle or a tiny, elaborate
nightie and end up spending more than you can afford on something that is
of no use at all, so it’s worth taking your time and doing some research.

The Australian Consumers’ Association’s magazine, Choice, publishes


their book, The Choice Guide to Baby Products, every year and it is an
excellent resource if you are full of doubt about what to buy.

It’s also handy to know about the StandardsMark™ (SAI Global). The
‘Five Ticks’ StandardsMark™ is a globally recognised logo confirming a
product’s reliability, quality assurance, and safety. When the
StandardsMark™ logo appears it means that the product has been
manufactured according to sound quality assurance programs and if used
according to the manufacturer’s instructions will do—safely—what it is
meant to do. For more information on SAI Global and the
StandardsMark™ go to www.saiglobal.com/shop.

Clothes
It’s a good idea to wait until late in your pregnancy before buying clothes
for your baby. As friends and relatives tend to like to give clothes as
presents you may only need a set of the basic clothing items.

A useful list follows. Variations can be made to allow for hot or cold
climates.

4 to 6 singlets or body suits. Body suits have sleeves (long and short)
and do up between the legs—they are cosy for the winter months.

6 to 8 nighties/jumpsuits and other outfits. Stretch jumpsuits are


incredibly practical, summer or winter, which is why you see so many
babies wearing them, but it’s nice to have one or two other outfits for
special times or a morale boost when you need it. The simpler the
clothes the better. Cotton is best next to your baby’s skin, but there are
many artificial fabrics or combinations of natural and artificial fabrics
which are soft and easy to wash and dry, so it’s not essential to go for
pure cotton or wool fabrics for the rest of her wardrobe.

4 cardigans or jackets.

3 brushed cotton wraps (cuddlies).

3 cotton or gauze wraps (cuddlies) for summer babies.

1 shawl or sleeping bag (for outings).

Hats, socks and leggings.

Bibs.

Tips on clothing
Sizes are a bit confusing because there is no standard way that
manufacturers use to work them out. A small size for a particular age in
one garment may be a large size in another; some go by chest
measurement and some go by length. Generally 000 supposedly fits
from birth to three months, 00 is for three to six months and 0 up to one
year; however, it seems 000 size is too small for most full-term babies
so buy 00 to begin with and move on from there.

It is compulsory throughout Australia to label children’s nightwear with


an indication of fire hazard. Small babies are not at risk of fire danger
the way active, older babies and children are, but it’s a good idea to
start reading and understanding labels on baby clothes which define the
fire hazard of the fabric. Labels indicate whether a garment is a low,
reduced or a high fire danger. Best to stay away from anything labelled
‘high’ right from the start.

Labelling of children’s night clothes


for fire hazard
Classification Description Labelling

Garment made from domestic apparel fabrics of the low fire hazard
Category 1 LOW FIRE DANGER
type.

STYLED TO REDUCE
Category 2 Garment design to reduce fire hazard.
FIRE DANGER

Garments which comply with the requirements given in Section 4 WARNING HIGH FIRE
Category 3 AS1249 but which do not comply with the requirements given in DANGER KEEP AWAY
Section 2 & 3 AS1249. FROM FIRE

Cuddlies are sometimes called bunny rugs. Some babies like to be


wrapped, others don’t. Either way, a cuddly is an inner lining that keeps
them secure when they are in bed or in their stroller. A shawl or blanket
goes over the top, when needed in cooler weather.

Hats, socks and leggings. Winter babies need beanies, bonnets or


helmet-type hats when they are out and about. Ribbons on bonnets are a
nuisance, sometimes irritating and can also be dangerous so it’s better
to go for a beanie or a helmet. Babies need cotton hats once they are
exposed to the sun, even on cloudy days. Hats should provide shade for
face, ears and neck.

Leggings are obviously for winter babies. Socks are useful most of the
year round. Mittens are not needed unless you live in a very cold
climate. Babies prefer having their hands free.

Avoid frills and ribbons on bibs, clothing (especially around the neck),
shawls and cuddlies, and avoid open weave fabric that small fingers can
get caught in. Loose threads in socks, mittens and clothing can wind
around fingers and toes, sometimes causing serious injury.

Bibs are often more decorative than useful. Bibs need to be large and
absorbent. Most babies throw up and some do it all the time. Just about
all of them dribble a lot until they are at least a year old.

Soft towelling bibs are absorbent and soft on baby skin. Plastic-backed
bibs stop clothes from being constantly wet but are not as efficient at
mopping up and are harder on skin. Pull-on bibs with T-shirt-type
ribbing around the neck instead of ties are easier to use than fasteners
and ribbon ties. Gauze squares are wonderful to use as mopper-uppers
and bibs or a range of different-sized squares are great. You can make
them yourself or buy them from specialist baby shops or department
stores.

Nappies
Years ago nappies were a major consideration. No liners, no nappy
soaking solutions, no nappy service, no decent pilchers and no
disposables! Modern ways have managed to eliminate most of the hard
work and inconvenience associated with baby bowels and baby bladders.
There are several choices:

Cloth nappies
You need between twenty-four and thirty. Terry towelling are the most
effective type of cloth nappy and need the following accessories.

PILCHERS: If you don’t have some sort of covering over your baby’s
nappy the washing and inconvenience is endless. Pilchers do not have to
be the old-style hard plastic pull-ons with tight elastic around the waist and
legs; many types are available made of soft plastic with a webbed fabric
lining and fasteners on either side. Using pilchers does not cause nappy
rash as long as the nappy is changed regularly.

Non-plastic thick cotton pilchers are an alternative if you prefer not to use
plastic, but as the baby grows, leakage and dampness can be a problem
with this style.

NAPPY LINERS: Nappy liners can be disposable or made of cloth.


Nappy liners make washing the nappies easier because they collect the poo
which can be neatly disposed of into the toilet. They also help prevent
friction on the skin from a wet nappy. If you’re using cloth nappies it’s
probably worth buying one box of disposable liners to start with and see if
you think they are needed.

Non-disposable nappy liners are made from a soft fabric that allows
moisture to pass through and so keeps the skin dry. They are relatively
expensive and not needed by most babies, but for babies with extra-
sensitive skin who are prone to nappy rash they are a boon. It’s important
to follow instructions for correct use.
FASTENERS: The use of safety pins for fastening nappies has become a
thing of the past but if you’re an old-fashioned girl (and you can find
nappy pins) go for the self-locking variety. Alternatively there are a range
of fasteners to choose from, which are easier and quicker than safety pins
and hold the nappy tighter as well.

TWO NAPPY BUCKETS: You need two good-size buckets with secure
lids. Always try the lids in the shop first—they must be difficult for you to
open.

If you wash your nappies in a water temperature of 65°C or hotter and dry
them in the sun there’s no need to worry about using a nappy soak solution
—just soak them in water or water and detergent. Stubborn bright yellow
baby poo stains will come out if soaked in a bucket of very hot water with
some powder bleach added.

If you are a cold water washer and/or generally use a tumble drier then it’s
advisable to use one of the nappy treatments available or try the following
for a more environmentally sound method (it saves money as well):

Scrape any solids off with a brush. Wash the soiled area with soap.
Dissolve one handful of salt in a bucket of very hot water. Soak nappies in
this solution overnight.

Tailored nappies
Tailored nappies are another nappy option. They are expensive initially but
fit snugly from birth until after toilet training, need no pins or folding (so
can be easier to use than standard squares) and can also last several
children. Tailored nappies make ideal gifts from fond relatives. Drying
them quickly can be a problem. They are available from selected
pharmacies, babycare shops or by mail order from baby/parent magazines
or the Australian Breastfeeding Association.

Nappy service
A nappy service brings you a couple of plastic bags full of clean nappies as
well as a bin with a liner bag for the used nappies. You decide how many
you need—up to seventy or eighty a week is standard for one newborn
baby. On an agreed day each week (or twice a week if needed) the used
nappies are taken away and the clean nappies left. At the moment nappy
services are not widely available outside capital cities and are expensive
compared to looking after nappies yourself, though some firms offer long-
term discounts, so the longer you subscribe, the cheaper the weekly cost
becomes. A nappy service is an ideal gift and, for those who can afford it
and have access to it, an alternative to disposable nappies. If you only use
it temporarily, you need to consider what to do when you have finished
using it.

Disposable (single-use) nappies


Disposable nappies are convenient and easy to use. The single-use nappy
market has expanded to include sizes and shapes according to age and sex,
the toddler ‘pull-up’ and the swimming nappy. Because of their
convenience 90 per cent of Australian parents now use disposables most of
the time.

In many respects the efficient disposable nappy is a dream come true,


especially for women in paid work and for all sorts of other situations—
multiple births, close births, overseas trips, holidays, long bouts of
illnesses and so on. I’m sure if they’d been available when my children
were babies I’d have used them.

But there are problems with disposables. Apart from the ongoing expense
that must be budgeted for, the two main ones are environmental and
behavioural.

ENVIRONMENTAL: Single-use nappies are not disposable and pose a


growing solid waste disposal problem that is still to be satisfactorily
resolved.

Disposables take years to decompose; conservative reporting estimates


100 years, other sources claim up to 500 years. ‘Biodegradable’ single-
use nappies are a recent innovation. Potentially they decompose more
rapidly than conventional disposables but the process requires oxygen
and water lacking in landfill operations. And biodegradable disposables
retain the plastic component that other disposables have which is not
compostable.
The manufacturing process required for disposables consumes more
raw materials and energy than the manufacturing process for cloth
nappies. Studies analysing the extent of these environmental costs
conflict with some claims made that the use of resources in the after-use
care of cloth nappies (water, energy, equipment and chemicals) cancels
out the difference unless nappies are washed in cold water and dried
outside in the sun. Other studies claim that single-use nappies use up to
five times more energy than reusable nappies.

BEHAVIOURAL: Single-use nappies have changed our behaviour.


Because of their convenience potty training is being delayed, toddlers are
in nappies longer, increasing the number of disposables being used.
Normal rules of hygiene seem to have faded into the past. Human poo now
gets dumped in places that would once have been unthinkable where it
eventually makes its way into landfill. There it is left untreated, seeping
into groundwater supplies with the potential to contaminate and transmit
disease.

Sensible use of disposables


Limit use by combining cloth with disposables. Bypass swimming
nappies and daytime use of ‘pull-ups’. ‘Pull-ups’ are simply nappies by
another name and delay potty training, and the reusable swimming
pants that are available are excellent.

Whenever possible put most of the poo in the toilet where it belongs. I
know this is difficult when it’s a liquid embedded poo, however a good
flush significantly reduces the amount going into the garbage.

Nappy-free
There is a tiny group of parents who are dramatically minimising nappy
use by holding their babies out over a pot (or the laundry sink or the lawn)
at regular intervals from birth. Potty training fashion in the last thirty years
has swung strongly in favour of waiting until the toddler is ‘ready’ and not
putting on too much pressure for fear of causing long-lasting psychological
problems. And there’s no doubt there is a risk that poo catching from a
young age for the wrong reasons or taking a militant potty training stand
with a reluctant toddler will cause problems.

Nevertheless, in many cultures nappies are still not used—babies are held
out from birth and by a year many are happily trained. In our own culture,
in another era when nappies were a burden, it was common to hold babies
out, have nappy-free times during the day and start more formal potty
training well before the second birthday.

In the cloth-nappy era, toddlers were much more likely to be trained soon
after their second birthday in contrast to today where nappy time seems to
be getting longer and longer—the convenience of single-use nappies are
almost certainly making a major contribution to this trend.

Parents taking the nappy-free route need to be united in the decision, have
a great deal of commitment and tolerance for some mess, and a lifestyle to
accommodate their choice. If it is done with the right attitude (relaxed not
competitive), for the right reasons (suits the family rather than to impress
the neighbours) it can be a very rewarding, self-sufficient way to go. For
more information go to www.sarahbuckley.com/articles

Nappies—the choice
Cost, convenience and baby comfort all have to be considered.
Individually, some babies’ bottoms do better with disposables, some with
cloth. A small number of babies are allergic to disposable nappies. The
skin in the nappy area turns bright red and the redness follows the exact
line of the nappy.

Cloth nappies need water and, ideally, a washing machine. Disposables are
the most convenient, an understandably major reason for their popularity.
Nappy services are limited to major cities.

The most economical and environmentally-friendly option is thirty good-


quality cloth nappies that are washed in cold water, and as often as
possible, dried in the sun. Good quality cloth nappies will also last several
children. The most expensive option is either exclusive use of ‘super
absorbent’ single-use nappies or a nappy service.

Sleeping equipment
Six or more bassinet and/or cot sheets: You can’t have too many of
these. They can easily be made up from larger sheets. A pillowslip
works well over some small mattresses while your baby is in a bassinet.

A mattress protector for bassinet and/or cot: These are available from
any stores that sell baby goods. A mattress protector is made of suitable
material with a waterproof backing. Alternatively a piece of blanket is
an option during the first three months.

Two blankets and a quilt (plain, no fringes).

A fitted mosquito net.

Something to sleep in: Most parents prefer to have their baby in a small
bed (bassinet) in the first three months but there is no reason not to put
your baby into a cot from the start if you are happy to do this. Parents
with triplets, for example, put their babies into cots from birth so they
don’t have to buy two lots of beds.

If you are looking for a small bed for the first three months don’t
overspend. The bassinets in maternity hospitals are ideal but a cheaper
version of them is not available for the home. Look for something that’s
not too narrow or too heavy. If it’s on a stand make sure it’s stable. It’s
important to have the bassinet at the right height for you so you don’t
have to lean over your baby—there may be times when you have to pat
her to sleep and it’s essential that you can do this comfortably.

Cute, colonial wooden cradles are quite impractical but if you do buy
one check the security of the pin. If the pin comes out, it may force the
cradle on an angle which can cause suffocation.

Mattresses
Mattresses are sometimes sold with an indirect message that they are
‘safer’ and protect against SUDI (see chapter 11). This message is implied,
not stated outright, but parents do buy these products believing they give
protection against SUDI. A conclusive link between SUDI and any nursery
product has not been established, so do not be misled by manufacturers’
claims when buying your baby mattress.
Babies are easier to settle and do seem to sleep better on a firm mattress.
Dense latex mattresses such as used in maternity hospitals are preferable to
softer ‘wobbly’ type mattresses—purely from a practical view of helping
babies to sleep better, not in relation to SUDI.

Cots
It’s essential that cots are safe, but a lot aren’t. The Australian Consumers’
Association’s magazine, Choice, does not have a lot of good things to say
about many cots, so for advice on specific cots I would recommend
checking out the range covered in their book The Choice Guide to Baby
Products before buying either a new or secondhand cot. Another resource
to use if you are unsure of the safety features to look for when buying
furniture or equipment is the Department of Fair Trading in your state. In
some states this is also known as the Department of Consumer Affairs.
Look online or for the phone number in the White Pages.

Cots with an adjustable mattress position (two positions) are very useful.
When your baby is still very young she will be up high at an easy reach for
you; as she gets older the mattress goes lower so she can’t fall or climb
out.

Here are a few things to look for, especially if you are buying a
secondhand cot:

1. Smooth, rounded edges—no sharp bits sticking in or out of the cot.

2. Decorative transfers, counting beads or cutouts in the headboard or


footboard are all potential hazards.

3. The cot should have high sides so your older baby can’t fall out. The
recommended measurement from the base of the mattress to the top of
the cot side is 600mm (2 feet).

4. The dropside catches should be child resistant and work smoothly and
efficiently.

5. The mattress should fit snugly in the cot—less than 25mm between the
mattress and the cot all round (especially important if you are going to
use a secondhand mattress).
6. The space between the bars should be between 50–85mm (2–3 inches).

7. Old paintwork on secondhand cots may contain lead. This can be a


problem if the paint is peeling so stripping and repainting will be
necessary. Take care when disposing of the leaded paint that has been
stripped.

8. Older, secondhand cots may have a cross bar which can be used as a
step by an older baby, so don’t buy one of these unless you can fix it
safely.

9. If wheels are fitted, two should be removed.

Cot mattresses
Once again, a firm mattress is preferable, so look for innerspring or dense
latex. Make sure the mattress cover is completely sealed so your baby
can’t get her head stuck between the cover and the mattress. Nothing
should be tied or attached to the mattress with tapes or elastic.

A good quality secondhand mattress is fine—give it a couple of days in the


sun before you use it. Despite media reporting from time to time (bless the
media, anything to give parents more to worry about) that secondhand
mattresses are dangerous because of certain bacteria that may lurk within,
Sids and Kids say there is no evidence to show an increased risk of sudden
unexpected death in infancy (SUDI) for babies who sleep on second hand
mattresses provided the mattress is firm, clean and well-fitting.

There’s no need to use pillows until your baby is about three years old,
most by this time are in beds.

Cot bumpers
A cot bumper is a fabric liner about 30cm (12 inches) high which
surrounds the inside of the cot above the mattress. It is held in place by ties
or elastic. Cot bumpers are designed to prevent babies from banging their
heads against the cot or getting their legs caught between the bars.

They are no longer recommended as their use poses significant safety risks
of strangulation and suffocation. Sids and Kids has also registered concern
about the decrease in air flow in cots when bumpers are used. To date no
evidence exists to show that babies have ever come to harm because they
bang their heads on the cot sides or get their legs caught between the cot
bars, so give cot bumpers a miss.

Staying mobile
In the car
Cars are almost an extension of the home and your baby is likely to spend
several hours every week in the car. An infant restraint will have to be
purchased and fitted into your car prior to the birth of your baby.

An Australian Standards approved infant restraint labelled AS 1754 must


be used. Many different brands are available and all restraints in Australia
meet the Australian Standards pass mark. The Australian Standard is
recognised internationally as the most stringent child restraint standard in
the world.

The following is a summary of the child restraint laws in Australia.


Legislation and penalties for non-compliance vary across the states. To
find out the law in your state, contact your local authority. For more
information about the law and types of restraints contact the traffic
authority in your state or territory.

Children younger than six months must be secured in a rearward-facing


restraint.

Children aged six months to under four years must be secured in either
a rearward- or forward-facing restraint.

Children aged four years to under seven years must be secured in a


forward-facing child restraint or booster seat.

Children younger than four years cannot travel in the front seat of a
vehicle that has two or more rows of seats.

Children aged four years to under seven years cannot travel in the front
seat of a vehicle that has two or more rows of seats, unless all other
back seats are occupied by children younger than seven years old in
child restraints or booster seats.

In NSW it is mandatory that all babies under twelve months travelling


in taxis must be secured in child restraints. Legislation and penalties
vary across the states. To find out the law in your state contact your
local authority. If you travel in a taxi without a restraint provided it is
recommended that you use your own child restraint.

Types of restraints available


Single-purpose (non-convertible) capsules are for newborns to about six
months or older depending on the size of the baby.

Dual-purpose (convertible) restraints are for babies from birth to about


six months in the rearward-facing position, but can be converted into a
forward-facing child car seat and used from about six months to about
four years of age. Select the car seat that most suits the size and type of
your car (convertible car seats sometimes do not fit very well into small
cars).

Fitting restraints
It is recommended that restraints be fitted by an authorised restraint
fitter. Incorrectly fitted restraints may not protect your baby in a crash.

All restraints should be attached to the restraint anchorage points in


your car. Sedans manufactured before 1976 and some station wagons,
light passenger vans and four-wheel drives may not have anchorage
points.

Anchorage points can be attached to any car by an authorised restraint


fitter.

If you fit a restraint yourself or if you are unsure who did the job, have
it checked. Call the road safety authority in your state for the nearest
Restraint Fitting Station.
Buying restraints
New restraints cost from around $250 to $350 (dual purpose). You can
also hire them from maternity hospitals, local councils and specialist
retail outlets. Call the road safety authority in your state for the nearest
approved rental plan.

Children with disabilities may need a specially designed restraint or a


Special Purpose Seat. Help with this is available from your nearest
Children’s hospital.

If you buy or borrow a second-hand restraint check that it has the


Australian Standard label AS 1754. Those marked AS E46–1970 must
not be used and are illegal. Restraints should not be if more than ten
years old.

If possible check the background of a second-hand restraint. If it has


been in an accident or shows any sign of wear, for example, cracks,
frayed strapping or faulty buckles, don’t borrow or buy it.

If purchasing a new restraint you may like to check out the Child
Restraint Evaluation Program website at www.crep.com.au which has
tested a range of restraints on the market and given them a safety and
ease of use rating.

Using an infant restraint in your car


Always put your baby on her back and never wrap her in a bunny rug
before you put her in the restraint.

Adjust the crotch strap on the harness first then adjust the shoulder
straps until they are firm. Make sure your baby’s arms and legs are not
caught under the straps and the harness buckle clicks when it is done
up. Remember to change the slots for the shoulder harness as your baby
grows.

The rear centre position is the safest place for the restraint but this has
to be weighed up against potential back injury for the adult getting the
baby in and out of the car so the left-hand side near the kerb-side door
is a reasonable option. Always take your baby in and out of the car by
the rear kerb-side door.

When your restraint is in the rearward facing position check that it is


not resting on the back of the front seat as this impairs the safe
functioning of the restraints.

Ensure that the handles are in the down position once the restraint is
placed in the car.

When you are on a long trip, stop and give your baby a break from the
restraint every couple of hours—when your baby is awake. Restraints
have been designed to carry babies safely in cars and are not meant to
be used as bassinet substitutes, so avoid leaving your baby in the
restraint for long periods.

Baby restraint accessories


A lot of accessories available are not approved and can compromise the
safety features of child restraints. Nothing should be put between the
restraint liner and your baby. Accessories such as head supports,
lambskin liners and padded mattresses are not approved, are not
necessary for baby comfort and can interfere with the safe working of
the restraint.

Sunshades over the restraint reduces airflow, traps heat and increases
body temperatures. To reduce heat and sunlight attach sunscreens to the
car windows.

Other car safety tips


Never leave babies or toddlers alone in cars for any reason. When you
leave the car parked in the sun make sure the buckles and seats are
covered as babies may be burnt.

Remove loose objects or sharp-edged toys from the car before making
your journey.
Carriers: slings, front-packs and
backpacks
As well as buying or hiring an approved baby car seat, you need to make
some decisions about what you will use for baby transport when you are
on foot or on public transport. Slings and front-packs are a very useful way
of keeping your baby next to you and your hands free. They are excellent
for trips to the supermarket, on public transport and for times when
carrying her next to you is the only way to calm her during an unsettled
period. They are not so practical for any situation where you have to carry
your baby for long stretches of time. If you buy a sling or carrier you are
unlikely to use it much after six months when your baby becomes heavy.
Also, they may not be a good idea for those with back problems.

Slings
A sling is a simple device that slips over one shoulder across the chest.
Your baby lies inside the sling across your body so her head is on your
chest. Some women find slings a great breastfeeding aid when
breastfeeding in public. Slings are more for newborns and up to the first
three months, although some parents use them for the whole of the first
year. Most babies, however, find slings too restrictive after the early
months and prefer to be upright, watching what’s going on. And many
parents find slings uncomfortable as the baby gets bigger because the
weight tends to be distributed unevenly.

Front-packs
A front-pack is more complicated and it can be tricky getting one on
and off until you get the hang of it (it won’t take long), but they are
designed to distribute the baby’s weight more evenly. There are many
varieties to choose from. Some hold your baby facing inwards until she
is around four to six months, at which time she can be turned outwards
to face the world. Others convert to a backpack when the baby is
between six and nine months.

Tips for front-packs


Look for one that’s easy to adjust (especially if different people are
using it) and get on and off on your own. Also, a wide bottom and
padded shoulder straps are more comfortable for both baby and parent.

Make sure your baby’s head is still supported securely when both your
hands are free.

Try to find a front-pack that is strong without being bulky and hot.

Backpacks
Backpacks are designed for babies from about six to nine months who
have good head support and are sitting (or close to sitting) on their own.
A baby/toddler backpack is similar to a hiking/camping backpack. If
you plan to use it a lot it is worth getting a more expensive model with
a frame that stands on its own, a waist belt and weather protection.
Backpacks are more for the hardy. They can be very useful for older
babies and toddlers who refuse to sit in strollers.

Prams and strollers


Selecting a carriage or stroller can be confusing, as there is now a wide
variety to choose from. Take your time and do some research so you can
work out what is best for your lifestyle and your budget. You will need
some sort of transport system from early babyhood to around age three.
Here is a sample of what’s available:

Traditional prams (heavy, can be more than 13kg, 28lb)


Prams are becoming a thing of the past, especially for people who live
up flights of stairs, in crowded cities or anywhere where there is rough
terrain to negotiate. Prams are very comfortable for young babies and
protect them well from the elements. They also have a springy, rolling
motion that can calm fussy babies, and usually have a removable carry
bed that can be used as a bassinet. Sometime between six and nine
months you will need to change to a stroller, which means making an
extra purchase.

Prams/strollers
These models convert from a pram (so young babies can lie flat) to a
stroller (once they are old enough to sit up or be propped up). Some
models have a removable carry bed that can be used as a bassinet. They
are expensive and relatively heavy (compared to the lightweight
strollers) but do grow with your baby.

Umbrella strollers (5.5kg, 12lb)


These have curved umbrella-like handles. They are easy to manoeuvre
in tight spots and easy to store. Step-up models include a canopy, an
adjustable seat and padding. Durability is often poor, you may need
several for one child, and the wheels (like the wheels on supermarket
trolleys) may not perform well on bumpy terrain (or sometimes even on
smooth terrain).

Lightweight strollers (5.5kg, 12lb)


These models are the most sophisticated (and often the most expensive)
on the market. They feature smooth folding mechanisms, thick padding,
a reclining seat, weather protection extras and built-in shock absorbers
in the wheel assemblies. Some models of these strollers are large and
while they are easy to push and manoeuvre, great for weather protection
and for putting baby to sleep, there is a growing criticism of them
because of their size. ‘Monster’ strollers, as they are often called, do
take up a lot of space in shopping centres and coffee shops, on narrow
streets and in public transport. Also, they sometimes don’t fit through
supermarket check-outs. Judging from media reporting on the topic, I
suspect increasing numbers of mothers are getting harassed when out
and about with their monster strollers. Much as I deplore this baby
unfriendliness in our community, if you live in the city it might be an
idea to consider a smaller version that has similar function and
convenience to the larger models. More and more stroller varieties are
arriving on the market; look around and take your time when selecting.
If you are planning on a second baby it is also worthwhile considering
buying a stroller that will accommodate a toddler and a baby.

N.B.: Take care when hanging bags on the handles of umbrella strollers
and lightweight strollers as heavy items can make the stroller tip
backwards onto the ground.

Jogging strollers
Jogging strollers have three large wheels mounted on a lightweight
frame. They are perfect for rough terrain and for taking your child on
runs or hikes. The bigger the wheels, the more space taken up in the
boot of the car and jogging strollers can be difficult to manoeuvre
around small spaces.
Strollers have become smaller, lighter and easier to push around in the last
ten years, but the perfect design to suit every purpose remains to be
invented. You may have to make a compromise.

Lately there has been some discussion about whether strollers should face
forwards (baby looking out away from mother) or backwards (baby facing
inwards towards the mother). Claims have been made that it is emotionally
and psychologically better for babies to face their mothers up to age twelve
months.

I am ambivalent about this; some babies will be happier facing their


mothers, others won’t care. As babies get older, say from six months
onwards, I think they are more likely to enjoy looking at the world but this
will vary from baby to baby. I don’t think there is solid research to show
that babies are advantaged or disadvantaged emotionally or
psychologically by the direction in which their strollers face however this
might be something you want to consider when you buy a stroller. There
are models that will go either way.

Essential requirements
Seat belts
Many strollers have inadequate restraints (for example, too loose, no
shoulder straps, non-adjustable). Ideally the stroller should have a
shoulder harness and a waist and crotch strap (especially for jogging
strollers), however, most models only have waist and crotch straps. The
buckle should be easy for you to operate but impossible for your
baby/toddler to unfasten.

Brakes
The wheels should lock when you engage the brake.

Leg holes
Pram/strollers that can fully recline must have leg holes that close so an
infant can’t slip through one of them.

Sturdiness and flaws


Shake the stroller and check that all the mechanics work smoothly and
efficiently, remembering you will often be opening and folding your
stroller while holding your baby. Look for flaws such as malfunctioning
wheels, frames that are likely to bend out of shape, faulty locking
mechanisms, loose seat belts, flimsy buckles.

Manoeuvrability
Can you push it and turn it with one hand? The best wheels are the swivel
type that move in all directions and can be locked when you are going over
rough surfaces.

Storage areas
How big is the storage bin under the stroller? Check how strong it is—it
shouldn’t drag on the ground when loaded. Storage nets fastened onto the
handles are suitable only for lightweight articles.

Warranties and return policies


Purchase your stroller from a store, catalogue or website that offers a 100
per cent satisfaction guarantee.

A final checklist
What is your price range? The range is $100 (umbrella strollers) to
$800+ (top of the range). Bear in mind that high price and good quality
don’t always match up. Choice tests have shown that some economical
strollers can perform as well as highly priced models.

Do you have back problems? Think about the weight of the stroller and
how much you might have to lift it.

Will you be lifting the stroller in and out of the car a lot?

Do you have many stairs to climb up and down daily?

What sort of terrain will you be pushing your stroller over?


What is provided for shopping? What happens to your shopping when
you want to collapse the stroller to get onto the bus?

Is it the right height for you and your partner? Can you push it without
damaging your shins? Do you need adjustable handles?

What extras do you need for weather protection?

Check the width; some strollers are much narrower than others. Extra
width can be useful.

Don’t forget, there are strollers that can accommodate a toddler and a
baby.

Baby cosmetics and baby baths


Most baby cosmetics are unnecessary products. Here’s a short list of
essentials:

Cotton wool balls and tissues.

A mild, simple soap.

A moisturiser—combined sorbolene and glycerine is excellent.

Disposable wash cloths or baby change lotion for when you are out.
Pump pack sorbolene and tissues are fine when you are at home.

A small jar of petroleum jelly.

Two soft bath towels and two washers.

Small blunt-ended scissors for cutting your baby’s fingernails.

The use of bath lotions instead of soap is common practice. As well as


commercial lotions designed specifically for your baby’s bath time, oils
such as jojoba or almond oil can be used. All of these products are fine but
not essential. Simple soap, water and some sorbolene and glycerine is
sufficient for most babies unless they have a dry skin condition such as
eczema (see chapter 19).

Buy small quantities until you know for sure which products suit your
baby. Wait until you need specific items before buying out the pharmacy.

Baby baths: The range is many and varied. One of the problems with
baby baths is emptying them when they are full without causing yourself
injury or making a terrible mess everywhere. Here are some possible,
convenient baby baths:

A large plastic wash bowl.

Any plastic baby bath designed for the purpose. Make sure it gives you
easy access to your baby. Baths with a moulded back support for young
babies are helpful.

The model that sits across a bath solves the problem of emptying but
will not fit on all baths.

Other bathing devices such as sling baths and cradling bath seats make
bathing easier initially and are helpful for parents with back problems,
but have to be replaced as the baby grows.

Bathing in the laundry sink is another option, providing your baby can’t
bump against the taps or get burnt on the hot tap.

Child safety products


In keeping your baby safe nothing can replace constant vigilance, planning
and commonsense, and making sure your basic equipment is not
hazardous. However, at each age and stage you’ll find there are some
items worth buying to help make your baby’s life safer. Safety 1st make a
range of child safety products at a good price and are available at World
for Kids, Toys R Us, Target and KMart.

During the first three months babies are fairly immobile, but there are a
few basic items worth considering, such as:

A low-power night-light in your room, your baby’s room and the hall.
An efficient torch.

A childproof lock or handle to the baby’s room.

A childproof lock on the laundry door.

A child-resistant cabinet for medicines.

Power point covers.

An emergency telephone number listing.

Curly cords for electrical appliances in the kitchen.

A non-slip mat in the bath and shower.

An automatic doorstop.

A chair for you: A suitable chair for you to breastfeed your baby is
essential. In general, low, soft lounge chairs or rocking chairs are not
great to learn to breastfeed in. You need a reasonably wide, firm chair
with good back support that is about 40–45cm (14–16 inches) from the
floor.

Optional extras
Change tables
Change tables are specially constructed tables to put babies on while you
change them, dress them, and so on. It’s much easier for you and kinder to
your back to be able to attend to your baby without bending over all the
time. A variety of change tables are available, some with storage space and
many with restraining straps. As babies can fall off, safety is an important
consideration when a change table or any high surface is being used.

The change table should be stable and strong, especially if there are small
children in your family likely to try climbing it. It should not be on wheels.
Some mothers couldn’t manage without change tables; others feel they are
a waste of money. If the change table can double as a place to store
nappies, nappy-changing equipment, clothes and so on it’s a lot more
useful.

Do you have room for one? Maybe a changing mat on a table or chest of
drawers would suit you better.

A portable baby chair


Most parents find these useful. They come in a soft, bouncy style or in a
stable, moulded plastic style. The stable style are preferable to the bouncy
ones (made of mesh) as they do not move when the baby moves and so
encourage better posture. This is especially important for premature babies
or babies with developmental problems.

Specialist baby bags called change bags, nappy bags


Important if you’re the sort who likes to be highly organised; alternatively,
any large bag will do. Make sure it can be cleaned and fits over the handles
of your stroller or buggy (remember heavy bags tip strollers over).

Breast pumps
I find this is the most common piece of equipment that is never used or
rarely used, so don’t rush off and buy one early on. For more on breast
pumps see chapter 8.

Baby monitors
Sound monitors
Sound monitors allow you to hear your baby cry when you are not
within immediate earshot. They work like a one-way walkie-talkie so
you can hear your baby’s noises but your baby can’t hear yours. There
is a variety of styles which cover a range of distances—room to room,
up or down stairs or out in the garden.

Sound monitors are becoming more widely used, and in certain


circumstances, may be useful. Many parents who attempt to use them
routinely overnight find that they increase rather than decrease their
baby-stress and, because their baby’s amplified snorts and snuffles fill
the room, prevent them from sleeping. Sound monitors are for
reassurance only. They do not monitor baby breathing or movement.
They are not protective safety devices, particularly in relation to sudden
unexpected deaths in infancy and shouldn’t be used as such.

Breathing (apnoea) monitors


Breathing monitors aim to detect slow or absent breathing. The baby
sleeps on a sensor pad under the cot sheet and if her breathing stops for
more than 20 seconds the light on the alarm box (attached by a wire to
the sensor pad) turns from green to red and the alarm starts. Similarly to
the sound monitor there is a variety of styles.

There is no evidence that breathing (apnoea) monitors protect babies


from sudden unexpected deaths in infancy. Many breathing monitors
drive parents mad with frequent false alarms rather than giving them
peace of mind.

They are not recommended for general use and are only advised for
babies in specific situations—a previous SIDS death, a very premature
baby and/or a very ill baby who has spent a long time in an intensive
care unit. They can be obtained from large public maternity or
children’s hospitals or hired from some manufacturers. Sids and Kids
will help parents who have had a previous SIDS death obtain breathing
monitors. It is important to get advice from a paediatrician about how to
use a monitor; what to do should the alarm go off; how to do heart–lung
resuscitation (all parents should learn this skill, see chapter 12); and
who to call in an emergency.

If you decide to use a breathing monitor simply to keep your mind at


ease you will also need to know the above.

Sleep position monitors


Sleep position monitors work by a button that is attached to the front of
the baby’s clothing which sets off an alarm if she rolls over onto her
stomach (for stomach sleeping in older babies see chapter 11).

In my opinion sleep position monitors are yet another commercial


response to parental anxiety. There is no research to show whether they
have any benefits other than a commercial benefit for the
manufacturers. These monitors are not recommended by Sids and Kids.
Dummies
A dummy is not an essential item and before you start using one it’s worth
looking at the advantages and pitfalls.

Advantages
Relieves baby and parent distress in the early months.

Allows the baby to fulfil her need for non-nutritive sucking without
being constantly on the breast.

Dummies can be useful in helping establish some sort of routine with


feeds so mothers have a more predictable day.

Dummies are very useful for calming sick babies, premature babies or
babies under lights who are jaundiced.

Disadvantages
Can interfere with initiating and establishing breastfeeding.

May increase the incidence of thrush. At times causes contact dermatitis


around the baby’s mouth under the plastic shield which surrounds the
teat.

Dummies contribute to sleep problems in some older babies.

Hazards such as tooth decay and safety risks are associated with
improper use.

Statistically, the use of dummies causes a higher incidence of ear


infections, gastroenteritis and respiratory infections.

Into the future—prolonged use:

There is a slight risk that dummy-sucking, similar to some thumb-


sucking (see chapter 19) will push teeth up and out to a degree that will
require orthodontic treatment. This seems to depend on the strength and
frequency of the sucking and in a tiny number of children, unusual
sucking habits.

When toddlers have dummies in their mouths twenty-four hours a day it


can inhibit speech and communication. Speaking clearly around a
dummy is difficult especially when a toddler is in the speech-learning
phase. A dummy also hides facial expressions so if it is never out of the
toddler’s mouth it’s hard to know exactly how she might be feeling.

Occasionally the prolonged use of the dummy during the toddler years
interferes with optimum muscular development around the mouth and
encourages tongue thrusting, resulting in excessive dribbling as the
saliva pools under the tongue and falls out instead of being swallowed.

The perplexing question of SIDS and dummies


Some studies suggest that dummies may have a protective effect against
SIDS. However, the downsides to dummies have to be weighed up against
this possibility.

As the evidence that dummies are protective against SIDS is inconclusive,


Sids and Kids do not recommend their routine use at this time. You can
obtain their information statement, Pacifier/dummy use from the Sids and
Kids website or by calling their office on 1300 308 307 to request a copy
via snail mail.

If you decide to use one, which type should you buy?


Choices centre around material and shape:

Shapes are either the bell shape or the more recently developed
orthodontic shape which manufacturers claim resemble women’s nipples
and is in some way advantageous to babies. This is based on very flimsy
evidence. Orthodontic dummies are not pliable and responsive like
women’s nipples so it is misleading to make these claims.

Bell-shaped dummies come in a variety of sizes ranging from small to


large. There are no advantages to any particular size apart from your
baby’s personal preference. If she prefers a small size there’s no need to
change the size as she grows.

The material is either rubber or silicone:

Rubber is softer, cheaper and more flexible. Concerns were raised in 1986
about the level of nitrosamines in rubber dummies and teats. Nitrosamines
are formed from chemicals added during the manufacturing of rubber to
give it elasticity, strength and durability, features which are desirable in a
dummy or teat. Nitrosamines are known to cause cancer in animals so the
fact that there are levels of nitrosamines in rubber dummies and teats was
widely publicised.

Interestingly, after an initial outburst this whole issue died down and
rubber dummies and teats continued to be sold and used. Rubber has been
used for ninety years and it is hard to find any evidence that it has caused
medical problems. Rubber dummies or teats which contain less than sixty
parts per billion of nitrosamines are considered safe by the National Health
& Medical Research Council.

Silicone is the other option. Silicone dummies are more expensive, harder,
less flexible, more durable and contain only negligible levels of
nitrosamines. Because they are less flexible they are more prone to tearing
and being bitten through so choking is a possible risk you should be aware
of.

Washing baby clothes


Baby clothes can be washed with the rest of the family clothes. They do
not need to be washed separately unless there is a medical reason for doing
so.

To buy or borrow—basic equipment


for the first three months
Clothes
4–6 singlets or body suits

6–8 nighties and/or jumpsuits

4 cardigans or jackets

3 brushed cotton wraps (bunny rugs or cuddlies)

3 cotton or gauze wraps (for summer babies)

Hats, socks or tights

Bibs

Nappies
Cloth (terry towelling) squares

Tailored

Disposables

Liners, disposable or cloth (optional)

Nappy buckets with lids

Sleeping
Bassinet and stand (optional) and firm mattress

Cot and mattress

6 or more bassinet and/or cot sheets

Mattress protector

2 blankets

Fitted mosquito net (optional)


Staying mobile
Sling, front-pack or backpack (optional)

Pram or stroller

Baby bag (optional)

Car safety
A standards-approved baby restraint

Baby bathing and cosmetics


Bath

Basic toiletries

Blunt-ended scissors

Change table (optional)

Miscellaneous
Child safety products

A comfortable chair for you

Portable baby chair

FOR MORE INFORMATION


Chapter 11: Daily Care (SIDS, use of baby cosmetics)

Chapter 12: Safety (for safe use of equipment, including car safety and safe use of dummies)

Chapter 15: The Crying Baby

Chapter 16: For Parents

Chapter 17: Equipment (portable cots)


Chapter 28: Sleeping and Waking Six Months and Beyond

FURTHER READING
The nappy-free bible is: Diaper Free! The Gentle Wisdom of Natural Infant Hygiene, Ingrid
Bauer, Plume, 2006.

If you would prefer to try a DVD: Nappy Free! Available from Moore Pictures, PO Box 50,
Repton NSW 2454.
6

Breastfeeding—The First Two


Weeks
Previous chapter | Contents | Next chapter
Breastfeeding is the normal way to feed babies. Breastfeeding and the
benefits of human milk have been promoted much more vigorously in the
last thirty years as research reveals more and more about the special
qualities it has, how they benefit babies and impact on adult health.

People who support, protect and promote breastfeeding do not do so to


make women who struggle with breastfeeding and wean feel guilty—some
of them bottle fed their own babies. Their information and efforts to
change our society’s approach to how babies are fed is aimed at the
product (human milk and formula), not the person.

If an interest had not been taken in breastfeeding by passionate individuals


and groups, breastfeeding may well have disappeared from our culture. If
the art and act of breastfeeding is lost, it is reasonable to assume there will
be far-reaching negative effects on the human race in the same way
irresponsible use of the environment is a potential threat to us all.

Think about the implications of our babies being completely reliant on


manufacturers to provide, indefinitely, safe artificial baby milk without
having the blueprint of the naturally-occurring biological milk that has
sustained human babies for thousands of years. Producing a suitable
substitute for the few babies who need it is a very different proposition to
completely replacing a superbly adapted evolutionary system which has
stood the test of time and demonstrated, unequivocally, its superiority over
anything else we have come up with—and are likely to come up with—to
replace it. One of the spin-offs of the renewed interest in breastfeeding
research has been a great improvement in the manufacture of formula,
which has made bottle feeding safer, so the protection of breastfeeding is
also about the protection of baby feeding.

Unfortunately, in the rush to promote breastfeeding, the ease and


enjoyment of it is at times unrealistically portrayed and the practicalities of
life as we live it overlooked. A woman’s decision to keep breastfeeding is
always influenced by support systems and we have not reached a stage
where appropriate support, resources, education and community awareness
is in place in Australia to have most babies breastfed for six months. We
also need to recognise that very few women ‘choose’ not to breastfeed.
When breastfeeding is abandoned it is usually not a matter of choice,
rather it is because the circumstances surrounding the breastfeeding make
it impossible to continue. The few women who do choose to formula feed
usually do so because circumstances make it impossible to continue or
because a previous breastfeeding experience was painful and stressful
and/or their babies did not thrive.

To help overcome the difficulties that can occur in the first six to eight
weeks it helps enormously to know what the advantages of breastfeeding
and breastmilk are for you and your baby. Doing what you can to prepare
yourself and your partner and having access to accurate information to
solve the solvable problems when and if they occur makes a great deal of
difference during the early weeks. Not all breastfeeding problems are
solvable, but the ones that aren’t can often be overcome with good support,
the right advice and a little time.

Feeding your baby cannot be seen as separate to other aspects of her life or
yours. Bear in mind that many of the difficulties with babycare have
nothing to do with feeding but simply with the way babies are, which most
of us find a challenge, and sometimes a trial, especially when we are doing
it for the first time.

Why breastfeed?
It’s the normal way to feed babies
Breastmilk is perfectly balanced and contains everything your baby needs
to grow and develop the way she is meant to. It’s easy to digest and
contains antibodies to protect her from illness and foster optimum brain
growth. Breastfeeding is good for your baby’s jaw development and
speech and breastmilk enhances her eyesight.

Exclusive breastfeeding for about six months delays the onset and reduces
the severity of conditions such as asthma, eczema and food intolerance.
Breastfed babies rarely get constipated when they only have breastmilk
and no other food or milk. Their poo is always soft. Current research also
suggests that breastfeeding may reduce the risk of heart disease in later life
and that breastfed children may have a lower risk of developing juvenile
diabetes and coeliac disease.

And, finally, in these current times of rising obesity amongst our children,
early research looking at breastfeeding and obesity suggests that children
who are breastfed have a lower incidence of becoming overweight or
obese—the longer the duration of breastfeeding the less the chance of too
much weight gain in childhood and adolescence. Obviously there are other
significant factors involved in the current obesity epidemic, but
breastfeeding has the potential to get things off to a promising start in
maintaining healthy weight. Reasons suggested by some studies include
less exposure to unnecessary calories, the presence in breastmilk of a
special protein thought to act as a satiety factor inhibiting overeating and
the ability of breastfed babies to adjust their own intake. And one study
found mothers of breastfed babies have more relaxed attitudes to their
toddlers’ eating habits.

It’s good for you


The hormones your body secretes when you breastfeed keep you calm.
Many women find the hormones also help with weight loss by making
their bodies work more efficiently.

Breastfeeding helps your uterus return to normal size after birth and speeds
up the blood loss so the bleeding after the birth is over quicker.

Breastfeeding delays the return of menstruation. Exclusive breastfeeding


without use of dummies, bottles or any other food is effective, natural
contraception.

Once you and your baby are breastfeeding well it is easy, convenient and,
of course, freely given and freely obtained, so it is easy on the family
budget.

A possibility that breastfeeding may reduce the risk of pre-menopausal


cancer of the breast, cervix and ovaries is indicated in some research. It
also suggests that women who breastfeed have a lower risk of osteoporosis
and heart disease in later life. Research in areas like this is difficult and
there are no guarantees, but they are an added bonus which you should be
aware of.

Breastfeeding is potentially sensual and pleasurable for mother and baby


alike. Skin on skin, close body contact—it is a richly emotional and
physical time, a delicate balance of nature and a wonderful way for you
and your baby to get to know each other.

Women’s experiences of breastfeeding are as diverse and individual as


everything else to do with babies. The issues surrounding baby feeding are
emotional, psychological, social and political. The concepts are complex
and a challenge for all of us to deal with whether we are parents, health
workers, baby food industry workers or bureaucrats who set policies on
infant nutrition.

The following are letters written to me about breastfeeding. I am including


them because I think they reflect the thoughts and experiences of women
generally and it may be comforting to read them if you are going through a
few dilemmas yourself.

A positive attitude
I guess I’ve been very lucky in that I grew up with very positive attitudes
on breastfeeding. I am one of nine children and my mother breastfed all of
us for about nine months each. When I had my first child I had no doubts
about my ability to breastfeed. To me, choosing to breastfeed in preference
to formula feeding is like choosing to feed the family fresh food as opposed
to tinned and frozen food. Many women are not given a ‘real choice about
baby feeding’ due to a lack of knowledge on the subject.

Why am I doing this?


I am currently breastfeeding my two-month-old son. If I were to give my
expecting friends any advice regarding this topic, it would be to
breastfeed. My rationale for this is as follows:

When you have a baby such as mine that wants to be fed every two and a
half hours, could you be bothered, screaming child in hand, heating the
bottle only to find that the baby has fallen asleep on you after five minutes
and the bottle has gone to waste?

You are portable. I can’t imagine what a pest it would be to go out if you
are bottle feeding. Have you got enough bottles? Are they sterilised? How
can you keep them cool? When you breastfeed wherever you go your milk
goes in a nice simple package. It is cheap. I have not had to buy formula
but I can imagine that it becomes very expensive.

Breastfeeding also helps you lose weight, or so I am told. Personally I


think you lose weight due to all the walking up and down the hall pacifying
the little gem.

Bonding? Well I am sure bottle-fed babies bond just fine too, but I am the
one feeding him. For the moment I am his lifeline. It is one hell of a
responsibility and perhaps one of the only times in your life when you are
truly useful.

Breastfeed just for the experience of it. I mean, we go back to our animal
forebears when we bear the child and breastfeeding is another one of
those experiences you do simply because you can. I am a bit vague on this
point, but in the same way people go parachuting for the sensation,
breastfeeding, while not as dangerous, is still done for the experience and
sensation.

Off the top of my head these are the issues I find to be most important.
However, let’s not kid ourselves—why don’t any of the books ever describe
the associated hassles with breastfeeding?

I think that we should all accept that there are people who want to bottle
feed for their own very good reasons. I think there are far more potentially
harmful things in store for our children; whether it be an electrical fault,
some misplaced medicine, or an accident when they get their driver’s
licence.

I mean, if I could have more than two hours of consecutive sleep I would
be the happiest person in town right at the moment.

Way of life
My belief is that unless a comfortable breastfeeding relationship is
established within the first two to four weeks, many mothers quickly opt for
the bottle. It seems many problems arise in those first few days of a baby’s
life. This is particularly distressing as every hospital, birth centre, clinic
sister and Australian Breastfeeding Association counsellor appears to
have different and often conflicting ideas. Without the support of loved
ones it’s not surprising the number of women who turn to formula feeding
to help them cope.

Probably the greatest thing I have learnt about breastfeeding is that it is a


‘way of life’. Much of our parenting skills are a direct spin-off of the
‘breast is best’ attitude. I am grateful to be parenting in this manner as my
son is a delight.

Encouraged to breastfeed
The lack of breastfeeding is a sad affair, but it slowly seems to be coming
back. I was encouraged to breastfeed my son which I did happily for a
year. He was ten weeks premature and I expressed my milk for eight weeks
until he was strong enough to feed from the breast. It was quite an ordeal
at first, expressing milk by hand and electric pump, but all worthwhile. My
son took to the breast as if it was what he was waiting for. It was a great
experience for both of us.

A non-breastfeeding experience
I am writing to let you know of my experience of not breastfeeding. I am
aware that there are pressures on women who decide to either breastfeed
or not to breastfeed. These are discussed in many publications and books
for pregnant women and new mothers.

There is almost complete silence on the subject of those women, like me,
who fail to produce milk at all. Does this indicate almost complete
ignorance about this problem? My experience indicates that it does.

My husband and I were in Canada for the birth of our son. Despite help
from a doctor, La Leche League, a lactation consultant, and tests from an
endocrinologist (which showed my hormone levels were normal), there
was no reason any of them could come up with for my lack of milk.

This time was very upsetting for my husband and me and we are still upset
and disappointed that breastfeeding information for prospective parents
does not make it clear that some mothers (if only a small number) are
unable to breastfeed. After telling friends of my problem they related
stories of people they know with similar problems. Thus I know I am not
alone in having this problem.
Didn’t connect with breastfeeding
While I was pregnant with my first child I had every intention of
breastfeeding. I read all the appropriate information. Unfortunately there
isn’t enough literature stating that not all mothers and babies can connect
with breastfeeding. This is agonising for a new mother as she is constantly
told to persist. Meanwhile her child is losing weight and crying continually
with hunger.

Sadly, I will never have the first seven weeks of my son’s life back to enjoy;
instead it was misery for this time due to so much emphasis being put on
breastfeeding. I don’t think I’ll breastfeed again because the experience
was far from fulfilling for me or my baby.

Let’s prepare women for the difficult aspects of


breastfeeding
To some first-time mothers the pain and stress involved in breastfeeding
comes as a total shock. The literature aimed at them only talks about the
pleasurable, positive aspects. Breastfeeding promoters need to realise that
talking about the difficult aspects of breastfeeding will help mothers
overcome the initial and subsequent hurdles to experience the positive and
pleasurable aspects. If health professionals cannot be realistic about the
difficulties of breastfeeding then how can emotional and sleep-deprived
mothers remain positive about the advantages breastfeeding offers
themselves and their babies?

The perfect product


My baby is now fifteen weeks old and I am breastfeeding her. Both she and
I are thriving. In the beginning I found breastfeeding painful and stressful
for both my husband and myself. I thought I wanted to give it up. My
health worker gave me lots of sensible advice and loads of encouragement
to continue. When I complained about breastfeeding she pointed out two
important facts:

Breast milk is the perfect food for babies

If I hang in there it will get easier.


She was right on both points.

The dreaded formula


I enjoyed the twelve months I breastfed my first baby. With my second
baby I had feeding difficulties from day one. He was placed in special care
because he was a low weight. Once my milk came in and we thought he
was feeding okay we went home to what was to become hell on earth. The
next six to eight weeks consisted of a screaming baby who was not gaining
weight. Eventually my family doctor (who was very supportive of
breastfeeding) was concerned that my son needed to gain weight so I
ventured to the chemist and bought the dreaded formula which I then fed
to my son. He not only drank it happily but then slept for five hours, the
longest he had ever done. It suddenly dawned on me that through my
stubborn desire to breastfeed and the feeling that mothers who bottle feed
weren’t really ‘good’ mothers I had probably done my son a disservice
who, in hindsight, had probably been hungry most of his life.

He went on to thrive on artificial milk and I think I have recovered from


my guilt and have tempered my feelings about breastfeeding. If I had
another child I would still do my utmost to breastfeed as it is ideal, but I
no longer look down on mothers who bottle feed.

Breastfeeding is worth the struggle


I am breastfeeding my six-month-old son and would not have it any other
way—now. However, feeding was a nightmare for the first eleven weeks of
his life and a desolate time for me. I so wanted to breastfeed and I’d read
about the techniques to use, but ‘your nipples may feel a little tender at
first’ was the understatement of the year. I wanted to lob a hand grenade
at those whose books had given me the expectation that breastfeeding
would be warm, comfortable and pleasurable. It is now, but it wasn’t then.

After struggling through sore nipples and recurrent mastitis, almost


weaning then having to re-establish my milk supply, I finally did it by the
time my baby was twelve weeks old. A supportive husband helped me stay
sane.

Establishing breastfeeding can be a lengthy, demoralising process. It’s no


wonder some of us, used to snapping our fingers to deal with difficulties,
reach for formula to solve the problems. I can still recall being amazed
that I, a ‘tough’ high school teacher who’d been able to maintain
discipline in all sorts of school situations, should be so beaten by a tiny
baby who simply needed to be fed.

I don’t think we should back away from saying ‘breast is best’. It is a


scientific fact that formula only approximates breastmilk, but we need
more realistic education about what can go wrong. We need it given in
detail so we can be prepared.

Breastfeeding is sensual and pleasurable


My son was born by caesarean section. Breastfeeding him was and is a
natural experience that is convenient and economical. The staff at the
hospital were very encouraging and actively promote breastfeeding
through lactation consultants giving presentations on the ward and
providing all the support needed.

I’d like to address some aspects about baby feeding. Firstly, mothers who
bottle feed feel at odds with breastfeeding mothers.

When I learnt that some of my friends weaned at two to five weeks I asked
how they found it in an attempt to learn of their experience. Their
responses were consistent—‘it’s great’, ‘more convenient’. I did become
aware of some minor conflict between the two methods from the mothers’
view point. I feel that breastfeeding mums feel compelled to defend their
position. Secondly, breastfeeding is sensual and pleasurable.

I found it interesting and comforting that you wrote of breastfeeding being


frequently sensual and pleasurable. I certainly found it to be both. It’s
something one feels inhibited to express but it does feel quite nice. This
aspect, I believe, is not made known by health workers.

What’s in breastmilk?
I think we sometimes lose sight of what it is the baby is getting and why
it’s worth persevering through the hard bits to make sure your baby
doesn’t miss out, so let’s look briefly at what it is.
Breastmilk is a living substance. Despite the wealth of information now
available, lots of things about breastmilk remain elusive and unanswered
so we are still a long way from manufacturing a substance that is an exact
equivalent.

One of the reasons precise breastmilk analysis is so difficult is because


human milk changes constantly. Breastmilk components vary from woman
to woman, from breast to breast, during the course of a feed and over time.
Human milk adapts to babies’ ages and needs and to climatic conditions.
Its taste varies, so breastfed babies are exposed to a variety of interesting
tastes from feed to feed. Women are usually aware of the difference in the
way their milk looks when it changes from the first milk, colostrum, to the
later milk known as mature milk. Colostrum is rich-looking and yellow
while mature milk is a light fluid often with a bluish hue. Milk from
different women can look quite different, and all variations are fine.
Human milk doesn’t look like formula which is uniformly dense and
white. They are different substances so this is to be expected.

Everything your baby needs is in her own special milk made by you. There
are over one hundred known ingredients. Let’s look at the main ones and
some of the amazing features of human milk.

Water
There’s lots of water in breastmilk. Water quenches your baby’s thirst and
during the early weeks helps make up for the water she loses from
evaporation from her lungs and skin. This evaporation is normal and is one
of the reasons new babies lose body heat quickly, so breastfeeding
contributes to maintaining your baby’s body temperature after birth. Even
in very hot climates babies get all the water they need from breastmilk,
clean and uncontaminated—your baby doesn’t need extra water in a bottle.

Fat
Fat makes up the next biggest part of breastmilk after water. The fat in
breastmilk is very well absorbed because of a special enzyme present in
the milk which makes the fat instantly ready to digest without having to be
broken down in your baby’s liver. Fat satisfies her hunger and is the main
way she gets her calories and puts on weight. The special fats in breastmilk
are quite different to fats in any other food or milk, and so far unable to be
replicated. These fats give your baby energy and provide essential
nutrients in the correct amounts and proportions that are needed for growth
and development of her central nervous system.

Breastmilk also has plenty of cholesterol, needed by babies for optimum


brain development at this time of their lives.

Protein
Protein is important for growth and development of every part of the body,
down to the tiniest cell. Humans grow slowly compared to other mammals
so the protein in their milk exactly suits the growth rate of human babies.

The two types of protein are casein and whey. The casein, or milk curd, is
soft and small and easy to digest. The whey, which is the clear fluid left
when milk clots, is also easy for your baby to digest. The whey protein
contains a lot of the antibodies that protect your baby from disease.

Carbohydrates
The main carbohydrate is lactose. Lactose makes it easier for babies to
absorb calcium—which compensates beautifully for the relatively small
amounts of calcium in breastmilk. Lactose also supplies energy to your
baby’s brain and contains a special carbohydrate known as ‘bifidus factor’
which helps stop harmful germs from growing in your baby’s gut.

Some other special things about breastmilk


Breastmilk contains living cells like those found in blood. They have
complex functions but are important in protecting your baby from illness
and delaying the onset of possible allergies.

Many hormones are found in breastmilk. Hormones are substances the


body produces which have a specific effect on a particular part of the
body. One of the hormones found in breastmilk is a growth hormone. The
exact role of many of the hormones found in human milk is still to be
discovered. It is reasonable to assume they all play some part in the growth
and development of babies. Breastmilk also contains vitamins, minerals,
iron (which is very well absorbed) and trace elements.

Breastmilk is an intriguing, living substance—the real benefits of which


are only just beginning to be understood. Breastfeeding is an extension of
birth and part of nature’s grand plan to help babies adjust to life outside the
womb.

Getting ready for breastfeeding


before the birth of your baby
Getting ready to breastfeed doesn’t mean doing things to your nipples and
breasts. Past ideas of toughening your nipples or pulling them out have
now been found to be unnecessary and even harmful. Preparation is about
learning how breastfeeding works, getting an idea of the best things to do
to make it work the way it should, and doing a little bit of flexible
planning.

Learning to feel comfortable handling your breasts by gentle massage


(using a technique similar to that advised for self breast examination) is
also helpful. If you are curious to see what your milk looks like or tastes
like express a little, gently, and see.

Here are some planning suggestions:

Read the early breastfeeding parts of this book before your baby is
born.

Breastfeeding is usually part of childbirth education classes so make


sure you go the night it’s on. Alternatively, many maternity hospitals
conduct breastfeeding classes.

The Australian Breastfeeding Association (ABA) is a national


voluntary organisation whose members help mothers and babies with
breastfeeding in numerous ways. ABA has trained breastfeeding
counsellors who you can talk to before the birth and help you
afterwards; making use of this wonderful resource is strongly
recommended.

Maternity hospitals have lactation consultants on their staff—midwives


whose job is specifically to help with breastfeeding. If you feel very
unsure about breastfeeding, an appointment to see a lactation consultant
before the birth will give you confidence before you start and will help
with any difficulties that may arise once your breastfeeding is under
way.

Plan to rest more than you usually do during the first six weeks until
your body adjusts to your new life and breastfeeding. The matter of
housework rears its head again and can’t be ignored—talk to your
partner about possible strategies.

Having someone you can call on who believes in breastfeeding and on


whom you can rely for consistent advice and encouragement is a great
boon. Research has shown that breastfeeding support from your baby’s
father is a tremendous help in getting breastfeeding started and
continuing through the first year and beyond. Other supporters might be
a child and family health nurse, an ABA counsellor, a lactation
consultant, a midwife or a close friend or relative who has breastfed.

Think about ways of avoiding the three Ss which are smoking, stress
and supplements. Women who smoke often find they don’t have quite
enough milk to keep their baby happy, especially after the first two or
three months. Constant stress that makes you feel unhappy and ill
means your body doesn’t work as well as it is able to, so try to change
stressful areas in your life before the birth. Learning relaxation
techniques also helps. Supplements, which are fluids given in bottles to
babies, may mean the end of breastfeeding if they are given in the first
six weeks, so avoid them. Water and juice are not necessary.

When breastfeeding problems occur


Baby Love covers the main problems women may encounter when they
breastfeed, but there are often many variations on the theme, some of
which respond to standard advice and some of which don’t. It’s always
advisable to consult a breastfeeding adviser if you run into difficulties you
can’t manage yourself.

I think it is wise to bear in mind that despite the fact a lot more is now
known about breastfeeding problems and how to manage many of them,
not all problems are solvable, even if you are seeing a knowledgeable
health professional. There is a great tendency nowadays to use a medical
model (diagnose and treat) to solve all breastfeeding difficulties, which is
great when it works, as it will for clear-cut problems. There are, however,
times when definitive diagnoses and treatments are given for problems that
may not be clear-cut. Subsequently women are sometimes put through
exhausting regimes and end up feeling let-down and frustrated when they
do not work, or even worried that they and/or their babies are different
from everyone else.

I think it is unfortunate that some health professionals involved in


breastfeeding are reluctant to acknowledge that there is not always a
guarantee of a successful outcome for the treatment or course of action
they are advising.

Things such as mastitis, blocked ducts, nipple dermatitis, nipple thrush and
low milk supply are eminently diagnosable and treatable. However, things
like breast refusal, repeated mastitis, breast pain, some cases of low milk
supply and some cases of painful/damaged nipples may not respond to a
specific diagnosis and standard treatment.

Why am I telling you this? Because I am aware that it happens, and it may
be a comfort, if you are going through a difficult breastfeeding experience,
to know that the breastfeeding experts do not know everything. While we
do know a lot more than we did, there remain times when particular
problems can’t be solved. Often with good support and when they can see
light at the end of the tunnel, many women continue to breastfeed through
the problems. Sometimes weaning is the only option (see chapter 7).

A word about flat or inverted nipples


Flat nipples are nipples which do not stand out when they are stimulated
by touch or cold. Flat nipples usually start to stick out once the baby is
feeding well and drawing the nipple out, but feeding can be tricky in the
early weeks.

Inverted nipples turn into the breast, so there is a dip instead of a nipple
standing out. It is more difficult to breastfeed if your nipples don’t stand
out as it makes it harder for your baby to get a good mouthful of the breast
tissue around your nipple. Inverted nipples provide a real challenge, but
women can succeed with patience, perseverance, help from a skilled
adviser and a baby who sucks well. Having said that, it must be
acknowledged that inverted nipples often present a considerable hurdle
which prevents some women from breastfeeding. In these cases breastmilk
can be expressed and given in a bottle.

Having flat or inverted nipples might discourage you from breastfeeding.


If you are concerned, check it out with someone reliable like a midwife, a
child and family health nurse, an Australian Breastfeeding Association
counsellor or a lactation consultant.

Special exercises and wearing breast shells (devices made of rigid plastic
that are placed over the nipple and held in place by a firm bra) during
pregnancy have been shown to be of little benefit, however, the use of a
nipple shield after the milk comes in for the first six to eight weeks after
birth can be a worthwhile strategy if the baby has trouble taking the breast
because of flat or inverted nipples.

How breastfeeding works


Breastfeeding involves not only your breast but your areola, nipple and
several hormones which are released by the brain. The areola is the area of
coloured skin which surrounds your nipple. The size and colour of the
areola varies a great deal between women and has nothing to do with the
way breastfeeding works. Dark hair on or around the areola is common
and doesn’t interfere with breastfeeding in any way.

Milk production
Milk production is inhibited during pregnancy by the hormone
progesterone which is produced by the placenta. Once the placenta is
expelled after birth the progesterone levels in your body fall. During the
next thirty hours as the progesterone decreases, milk production increases
and while this is happening your baby takes in small amounts of
colostrum. Colostrum is rich in good things which protect her digestive
tract, respiratory tract and urinary tract against infection, as well as helping
her gut and bowel to function efficiently. After this time milk production
rapidly increases to meet your baby’s needs.

Sound research indicates that breasts can produce more milk than required
by the baby and that within a few days of birth each breast begins to
regulate its rate of making milk according to the amount of milk the baby
removes at each breastfeed. Feeding well and often in the first days and
early weeks means your breasts get a clear message to keep making milk.
As your baby and your body become more skilful at breastfeeding, the
milk supply and release becomes very efficient, which is why sucking time
decreases as your baby grows, not increases as you may imagine.

Releasing the milk


After the milk is made, the breast has to release it. As your baby sucks, the
nerves around your nipple send a message to your brain to release another
hormone called oxytocin. Oxytocin contracts the muscles around the milk-
producing sacs in the breast, squeezing the milk down towards the nipple.
Oxytocin is the same hormone that contracts the muscles of the uterus,
drawing it tight—a feeling ranging from pleasant to painful. Painful
contractions of the uterus while breastfeeding are not permanent and only
last for a short time after birth. The contraction of the milk sacs by
oxytocin is called the ‘let-down’, a feeling that may range from not being
able to feel anything, to tingles, to pins and needles, to a needle-sharp
sensation which is painful for some women for a while. Some women who
breastfeed well never feel a let-down. Let-downs occur in between feeds,
from one breast while you are feeding from the other, at times when you
are thinking about your baby or if you hear her cry. Feeling sexy can also
start a let-down or alternatively a let-down can make you feel sexy—the
latter doesn’t happen to everyone, so if it happens to you, half your luck.

Getting started—the first two weeks


Breastfeeding is natural, but not something all mothers and babies know
how to do. There’s no doubt that a lot of babies and breasts go well
together right from the start and the whole experience is a smooth
operation that just happens. For others it’s a skill to be learnt like riding a
bike or learning to swim. The learning is made more complicated because
there’s two learning together, a bit like learning to have good sex.

There are two important things to remember when you start breastfeeding:

Frequent good sucking removes the milk, which tells the breast to make
more milk and stops the milk from banking up. Banked-up milk causes
painful breasts, sore nipples, much less milk and a hungry baby.

When your baby takes the breast the right way everything works well.
Good sucking and comfortable feeding depends on you both being in
the right position.

Let’s look at getting the position right


Getting both your posture and your baby’s position right each time you
feed is sometimes not easy in the beginning, although the basics are fairly
simple. Like any practical procedure, learning how to breastfeed from
written instructions is difficult—imagine learning to drive a car from a
book! It’s of great benefit to get help from an experienced person who can
guide you and your baby for the first several feeds. This is likely to be a
midwife or a lactation consultant. The following basic guidelines are
suitable for most mothers and babies. However, as all breasts and babies
are different, a number of women find they need specific help tailored to
their requirements. Most hospitals and communities in Australia have
lactation consultants available who are skilled at working out what
changes individual mothers and babies need to make to help their
breastfeeding become more effective and comfortable. If you find you are
having difficulties after you leave hospital, ask your child and family
health nurse how to contact an experienced lactation consultant. She/he
can closely watch you feed and help you by making recommendations
adapted to you and your baby.

While the ideal time for the first breastfeed is within a few hours after
birth, there are times when this can’t happen, so don’t panic if something
delays the first feed. Breastfeeding can work at any time after birth, even
weeks later.

Here are the main things to think about and do when you breastfeed your
baby:
When your baby is awake and ready to feed, make sure you are both
comfortable before you start. In the beginning you need to think things
through step by step. Empty your bladder, wash your hands and have a
glass of water close by (breastfeeding makes you thirsty). Have a
footstool or telephone book handy in case you need something to put
your feet on. Don’t worry about changing your baby—unless there is
poo everywhere—at this stage if changing her is going to result in a
distressed, screaming baby.

Finding a comfortable position for yourself is easier if you are not


holding your baby at the same time. Ask someone to hold her if she is
crying or leave her somewhere safe within easy reach until you are
ready.

While you are getting used to handling your baby and getting the
position right, sitting in a straight-backed chair (like a dining room
chair) that gives you good back support is best.

Lying on your side may be a better way to feed after a caesarean or if


your bottom is sore, but as it is difficult to see what your baby is doing,
ask for help.

Most women find it easier to use a pillow to support their babies while
they are learning to breastfeed. Your lap needs to be almost flat, your
trunk facing forwards and your back straight (not tilted back or leaning
forwards). Sit so your legs are down with your feet flat on either the
floor, a footstool or a telephone book.

Feeding babies unwrapped has many advantages. It lessens the


likelihood of the baby becoming too warm and sleepy to feed well,
there is more direct skin contact and the baby’s hands on the breast help
stimulate the milk supply. You may find, however, that you prefer to
wrap your baby until you are more used to handling her and your breast
(it won’t take long). Make sure if you do wrap that your baby’s hands
are wrapped either down or up and not across the front of her chest, as
this forms a barrier between her and your breast.

Hold your baby so she faces you, her chest against your chest. Support
her behind the shoulders with her body flexed around your body so that
her nose (not her mouth) is level with your nipple. You may find it
helpful to tuck both her legs into your armpit area, holding them firmly
in place with the top of your arm (like a set of bagpipes—forgive the
comparison).

There are various ways to support your breast and you may try several
before you find one that suits you both. For starters, try placing your
palm and fingers flat on your rib cage, bring your fingers forwards
along the side of your breast and cup the breast between the fingers and
thumb.

She needs to take a good mouthful of breast, so wait until her mouth is
wide open before you bring her to the breast. When your baby’s cheek
is touched, a reflex called the rooting reflex makes her turn her head in
the direction of the touch and open her mouth to suck. You can help her
open her mouth by gently brushing your nipple against cheek and lips
or by running your nipple lightly over her nose and lips.

When her mouth is wide open, move your baby quickly up to your
breast. Her chin should reach the breast first and tuck well into the
breast with the bottom lip curled back. Support your baby’s head and
shoulders so the nose and forehead can extend slightly, allowing for
good air circulation while your baby feeds. When the position is correct
you do not have to press the breast with your finger so she can breathe.
If her nose and forehead are pushed into the breast it becomes more
difficult for her to suck and breathe and she may go to sleep after only a
short suck.

A lot of the areola will be in her mouth but you will still see some of it
above the nipple—the bigger the areola the more you will see.

When she starts to suck, take a deep breath, make your shoulders go
floppy and feed away. Once your baby gets going she will suck deeply
and strongly at a regular pace. You will see her jaw moving and her
ears moving slightly.

You may experience a drawing sensation at first; some women find this
painful for about thirty seconds. If any discomfort or pain persists after
this or if your baby sucks quickly and lightly all the time and is sucking
her cheeks in, take your baby from the breast. To do this place your
finger in the corner of her mouth to break the suction, then gently
remove her. Try again. Sometimes it takes several tries before it feels
right.
Every time you feed think carefully about how you are doing it. This
may seem tedious, especially in the middle of the night, but it is the best
way to prevent sore nipples. After the first six to eight weeks you will
find you and your baby are such an efficient team you won’t have to
think about what you are doing, where you are sitting or even have to
use a pillow.

A good mouthful of breast


A good mouthful of breast means your baby takes in part of the breast
tissue around the nipple as well as the nipple and draws the nipple right
back past her hard palate. This protects the nipple and is a major factor in
preventing painful feeds.

Think about the difference between sucking the skin on your forearm and
sucking your finger. To suck the skin on your forearm you need to open
your mouth wide to get a good mouthful of skin and it is a similar action to
what your baby does at the breast. Sucking your finger, however, does not
require an open mouth or a big mouthful. When babies suck like this to
feed, nipples quickly become sore, the breast is not well drained and no
one has a nice time.

A summary of the most important points


Sit with a straight back and flat lap with good support for your back.

Hold your baby so she faces you, her nose in line with your nipple.

Bring your baby up to your breast. Let her take a good mouthful. Don’t
lean forwards and give her your nipple.

Her chin should be tucked well into the breast, her nose and forehead
slightly extended.

Take a deep breath and make your shoulders go floppy.

If it hurts after thirty seconds gently take her off. Avoid pulling. Try
again.
What about twins?
Women’s marvellous bodies respond to the stimulation of two babies
sucking and can produce enough milk for more than one baby.

The basics are the same. The decision has to be made whether the babies
will be fed separately or together. In the early weeks it is probably better to
feed one at a time until you become more confident and the babies are
feeding well. After a while it is usually easier to feed them together. You
will need help to master this as well as privacy and peace and quiet.

Trying different positions, feeding one at a time and two at a time while
you are in hospital with the support of the staff, is a good idea. I find that
everyone who breastfeeds twins does it slightly differently, so don’t get
bogged down by ‘rules’.

Eventually it is a good idea to swap breasts from feed to feed as some


twins become so attached to one breast they will not use the other one,
which may cause great inconvenience further down the track.

Weighing babies
Some health workers, both in the past and present, have been obsessed by
the issue of a baby’s weight. This is seen as disadvantageous to
breastfeeding by many mothers and people involved in supporting
breastfeeding. Constant weighing of breastfed babies with an
unsympathetic health professional who makes incorrect assumptions from
the baby’s weight can indeed be most unhelpful and work against
successful breastfeeding. Test weighing (weighing a baby before and after
a feed to see ‘how much she gets’) is pointless and stressful and should
never be inflicted on a mother—so if it’s ever suggested to you, change
your adviser.

When a baby is breastfeeding well, has six to eight pale, wet nappies and a
good soft poo either frequently or every so often, and there are no
problems, weighing is unnecessary apart from the nice buzz it gives a
mother to see a tangible sign of the great job she’s doing. It can also be a
very positive, reassuring thing for women who are breastfeeding for the
first time.

If problems arise there are times when weighing the baby to assess weight
gain (as opposed to static weight or weight loss) is necessary to give the
mother appropriate guidance, particularly when the problem is a crying,
unsettled baby. Certainly, many problems can be sorted out without
weighing, so whenever I suggest weighing in this book it is because I think
the baby’s weight is very useful information on which to base advice in
that particular instance.

How long and how often to feed?


There are no set rules about the length of time babies need to suck to get
the milk they need. Some babies get all they need quickly, others take
longer. In the past problems were caused because the general guidelines
suggested short rather than long feeds; now some women have problems
with the current standard advice which suggests leaving the baby to decide
when to come off the breast. There is also a lot of unnecessary advice
about foremilk and hindmilk.

Many women are needlessly worried by the whole concept of foremilk and
hindmilk so let’s get it out of the way now so you can forget about it.

The composition of breastmilk changes as milk is removed from the breast


at a feed. Usually the milk at the beginning of a breastfeed (the foremilk)
has a fine blue appearance which changes to a denser whiter appearance
(the hindmilk) as the breast becomes emptier at the end of a feed. The
change in appearance of the breastmilk occurs because the fat content of
the milk increases as the breast is emptied. However, these changes vary
greatly as the baby rarely removes all the available milk at any particular
feed. The important point is that the changes in breastmilk even out over
each twenty-four-hour period and you do not have to be concerned about
it. It is not possible to change your baby’s energy intake by altering your
pattern of feeding—your baby cannot consume consistently either low fat
foremilk or higher fat hindmilk.

In my opinion, the role of foremilk/hindmilk imbalance in what is called


‘colic’ is minimal, if it exists at all. I have seen no clear evidence in my
work that it is a reason or answer for crying, unsettled breastfed babies.
The main thing for you to be aware of is that you don’t have to worry
about foremilk and hindmilk: just think of your milk as breastmilk.

It would be nice if breastfeeding just happened and there was no need to


offer advice to mothers, but if you’re doing it for the first time you may be
looking for something to hang your hat on in the early weeks. Some
women breastfeed in whichever way suits them and never have a problem,
so if you’re doing just that, for goodness sake don’t change a thing.
Others find the standard advice works well; again if you and your
baby are happy, carry on.

However, if you are looking for more structured breastfeeding advice to


help you through the first six to eight weeks, here are my guidelines.

The longest babies need to get enough milk and comfort is around
twenty minutes or so of good sucking on one or both breasts. Lots of
babies finish in under twenty minutes, which is fine. If you are
happy to leave your baby sucking longer than twenty minutes, keep
going. If you would sooner finish the feed, gently take her off and offer
the second breast. It’s quite all right for you to end the feed after about
twenty minutes rather than wait for her to come off the breast by
herself.

Always offer the second breast—there are no advantages to ‘one-breast


feeding’ apart from times when there may be temporary difficulties
with an oversupply (see chapter 8). Before you offer the second breast,
wake your baby up so she is alert and ready to feed. Change her nappy
if you have to or tickle her feet. If she is not interested in the second
breast she is getting all the milk she needs at this time from one breast.
This is rarely a permanent arrangement and may vary from feed to feed
and over time. As babies grow they usually take both breasts at most
feeds.

When your baby only takes one breast you may need to hand express
the other breast for comfort. If the breast is comfortable don’t worry
about expressing.

The number of times you feed your baby in the first week or two varies
from six to eight every twenty-four hours. After your milk is flowing,
six to seven feeds suit most mothers and babies. Less than six feeds
over twenty-four hours usually lessens the milk supply over time, more
than six is fine as long as you are both happy. Some of the feeds will be
two hours apart, some three to four, and your baby may have one long
sleep of five or six hours. Stay flexible about feed times. If you are
looking for some sort of pattern, it is better to think in terms of the
number of feeds every twenty-four hours rather than three-hourly and
four-hourly feeds. Expecting a set four-hourly feeding routine is
unrealistic for most babies.

Some possible breastfeeding positions…


The important thing is that both you and your baby are comfortable and relaxed…

How can you tell if your baby is hungry?


Working out whether babies are hungry or not is confusing as babies cry,
suck their fists and make mouthing signs when they are over-tired, over-
stimulated or generally distressed, as well as when they are hungry.
Feeding breastfed babies to comfort them for any of the above—rather
than because they are due for a feed—is not harmful to the baby in any
way, but being worn out from too many feeds and an unsettled baby is a
common problem for many women in the first three months. If this is
happening to you here are two simple things to check:
Your baby’s position at the breast and sucking technique. If you have
an adviser to call on, so much the better.

That your baby is getting enough milk. The best way to do this is a
quick weigh with a sympathetic adviser who uses the weight as a guide
to help you and your baby—not worry the life out of you.

Most of the time, endless feeding and an unsettled baby fall into the broad
range of normal baby behaviour and are not breastfeeding problems, so
there is rarely a quick, easy answer once hunger and poor positioning are
ruled out. If your baby is bright-eyed and alert, sucks well, is gaining some
weight and is wetting and pooing, but is never ‘off the breast’ and you are
feeling very tense, see if you can limit some of her feeds. Limit the time at
each breast to about twenty minutes and wait two to two-and-a-half hours
before feeding again. Try other ways of settling her. This advice is for
your sanity, not because endless feeds will harm her—you cannot overfeed
a breastfed baby. You may also find it helpful to refer to other sections of
the book that deal with low milk supply, crying and sleeping and the
crying baby (see Search terms at the end of the book).

Very few women breastfeed in exactly the same way. What works for
another mother and baby may not work for you, so stick to your own style
and ignore unwanted, uncalled-for advice. On the other hand, you can
always change what you’re doing if someone suggests something that suits
you and your baby better.

Common difficulties in the first week


Your baby won’t suck
FULL-TERM HEALTHY BABIES: Recommendations for getting
breastfeeding off to a good start include offering the baby the breast as
soon as possible after the birth. And while many babies do take the breast
well soon after birth, others are simply not interested. It can be very
stressful for the mother when those around her keep trying to encourage a
reluctant baby to take her breast. When the birth is a normal one and the
baby is full-term and healthy it is best to stay relaxed about the early
breastfeeds. Some babies do not start sucking well for two or three days.
Remember that newborn babies have quite a lot of food in reserve.

SLEEPY BABIES: Babies may be sleepy if they are jaundiced, a few


weeks premature or if they are recovering from a long or difficult labour.
Sometimes it can take two to five days before they start to suck well. Try
to stay relaxed and patient. Sleepy babies start to feed very well when they
‘wake up’ two to four days after birth. Unwrap your baby when you put
her to the breast as skin-to-skin contact helps stimulate her senses.

BABIES WHO FIGHT THE BREAST: Some babies thrash about, move
their head from side to side and scream. Like a lot of things babies do, it’s
often difficult to know exactly why they do it because they can’t tell us. If
this is happening to you it can turn into a cycle where your baby becomes
more and more tense and you become more and more distressed, dreading
the thought of putting your baby to the breast. Happily, this sort of
situation is usually short-lived. The cycle can be broken by having a third
person, not as emotionally involved with the baby, to help. If there is no
professional help available a calm neighbour or friend could fit the bill.

Here are some tips for your helper:

Separate mother and baby. Calm the baby and see if you can help her
go to sleep.

Nurture the mother. A cup of tea, a bath or a shoulder massage all help.

When the mother and baby are calm and comfortable, try another feed.
The mother should express a little milk before starting the feed to
encourage the baby to suck. This softens the areola, making it easier for
the baby to take the breast.

Skin-to-skin contact can be very helpful or, if the mother is comfortable


with the idea, feeding the baby in the bath helps.

Expressed milk or boiled water may be given by bottle and teat if


necessary. This is usually not required as most babies do tend to start
feeding well before any extra fluid is needed.

Engorged breasts
What are engorged breasts? Engorgement refers to painful, swollen breasts
usually caused either by the milk not flowing well or because the breasts
are temporarily producing far more milk than the baby needs at each feed.
It can happen in the early days or later.

In the first two to four days your breasts may feel full and heavy
because of the increased blood supply to your breasts as they get ready
to make milk. Discomfort is variable and passes quickly as long as your
baby feeds frequently and she is positioned so she can suck well to
drain the breast.

Later engorgement—painful, swollen breasts persisting after the first


few days—means too much milk is stored because too much is being
made and not enough is being removed. The areola is stretched and
distended which makes it difficult for your baby to get a good
mouthful.

What can you do?


Feed often, eight (or more) times in twenty-four hours.

Waking babies to feed often doesn’t work, so put your baby to the
breast whenever she is awake and ready to suck.

Ask for help if it’s available to make sure your baby is in the best
position to suck well.

Avoid giving any fluids from bottles.

Gently hand-express a small amount of milk before the feed to soften


the areola to make it easier for your baby to take the breast.

Stand with your back to the shower so the hot water spraying down
doesn’t increase the discomfort. To relieve the pain and full feeling
express a little milk in between feeds under the shower. Placing cold
packs on your breasts also helps them feel better. To make a cold pack
soak a clean face washer in cold water. Wring out hard and place in a
plastic bag in the freezer.

If it all becomes unbearable, the cycle can be broken by completely


draining both breasts with an electric pump after a feed. This brings
relief and makes it easier for your baby to take the breast at the next
feed. It should be done once only, preferably at the end of the day and
with some help from a breastfeeding adviser.

Take some anti-inflammatory medication for pain if you need to, it


won’t hurt your baby.

Not enough milk/fluid


Occasionally babies become dehydrated in the first week because they are
not getting enough milk. The reasons for this vary. Sometimes it is because
the baby is not sucking efficiently; sometimes the milk supply is late
coming in; sometimes it is a combination of both. This can sneak up on
new mothers especially if it is their first baby. I must stress it is unusual,
nevertheless it’s useful to know the signs and symptoms of dehydration:

A floppy and sleepy baby not waking to feed at least six times every
twenty-four hours.

Sucking weakly or only for a short time before falling asleep.

You may be aware that your breasts are not full and feel the same
before and after feeds.

Nappies are dry or only damp.

Splats of khaki or black poo.

Increased jaundice (yellow colour of skin and whites of eyes).

Loose skin around your baby’s neck, back and tummy.

There may be pink/orange staining in the nappy (see chapter 10).

You need to see a health professional (family doctor, paediatrician,


lactation consultant, child and family health nurse, children’s hospital
casualty) as soon as possible.
Strategies to treat dehydration
Frequent short feeds alternating each breast after three to five minutes.

Setting the alarm and waking your baby during the night.

If necessary extra fluids (water or formula) via a supply line (see


chapter 8) or bottle can be used on a temporary basis.

Twice-weekly weighing until things are back on track.

Baby won’t burp


Burping babies is more tradition than necessity. For some reason it is
indeed very satisfying to hear a baby burp (I enjoy it too), but medical
problems don’t happen because babies don’t burp and in many cultures it
is an unknown practice. An unnecessary emphasis is placed on ‘getting the
wind up’ in our culture, which is unfortunate as it worries the life out of
new mothers. Whether a baby burps or not is not related to unsettled
behaviour, vomiting or interesting coloured poo. It’s fine to put your baby
to bed without hearing a burp first. Babies won’t always oblige with a burp
no matter how experienced the burper, so don’t think everyone in the
world knows how to burp a baby better than you. No secret tricks exist!
Try for a few minutes then forget about it.

Sore nipples
Sore nipples remain one of the most troublesome aspects of early
breastfeeding for many women. Past theories on sore nipples dwelt on the
necessity of having to toughen up the nipples and making sure babies
didn’t suck for too long. Current research shows that neither of these
things are relevant in avoiding and treating nipple problems; rather, the
way the baby takes the breast is the crucial factor.

This is why there is now so much emphasis on getting the mother’s and
baby’s position right for a feed. If positioning is right for all the early
feeds, nipple problems can be avoided a lot of the time. However, despite
current knowledge and the best efforts with correct positioning, sore
nipples are still with us. This may be because the damage can be done
during only one feed in the early days when the mother is tired or
uncomfortable and the baby doesn’t quite take the breast in the best way.
Once nipples become sore, comfortable feeding is difficult so the problem
gets worse.

Sometimes nipples get sore even when the feeding position seems to be
right. This may be because the nipple and areola are being used constantly
in a new way which causes temporary discomfort.

Nipple discomfort, pain and damage can be experienced in a number of


ways.

Many women find their nipples are sensitive when hormonal changes
take place—for example, pre-menstrually, during early pregnancy and
the first few days after having a baby. If you have sensitive nipples you
may initially find breastfeeding uncomfortable or painful at the
beginning of a feed. The discomfort should only last up to thirty
seconds. Sensitive nipples become less sensitive as the weeks go by,
but a small number of women have sensitive nipples for up to three
months while they are breastfeeding.

Sore, grazed or blistered nipples are all signs of a damaged nipple. The
nipple looks red and raw and sometimes there may be a blister which is
filled with blood or clear fluid. See if you can get help as soon as
possible to position your baby.

Cracked nipples: A split appears which may be on the nipple or areola


or both. A common place is where the nipple joins the areola.

What can you do?


Get help to get the position right. If you are in hospital, ask for help
from the staff.

In the community you can visit your child and family health nurse, talk
to an Australian Breastfeeding Association counsellor or in some areas
there are community nurses/lactation consultants who help with
breastfeeding problems at home.

Remember to think carefully at every feed about your posture and


position as well as your baby’s. Don’t leave your baby sucking if it
continues to hurt after the first thirty seconds. Gently remove her and
try again. Sometimes in the early weeks you might find you have to do
this three or four times before it feels right.

Fresh air and a little reflected sunlight helps.

Gently hand express for about thirty seconds before feeding to soften
the areola, draw out the nipple and start the milk flowing.

Much as it would be nice to apply a magic cream or cure, there is no


consistent evidence that any of the commonly used creams, sprays and
ointments make any difference. Other cures such as grated carrot,
geranium leaves and so on all appear at regular intervals, often hailed as
the long-awaited answer to sore nipples. I have never seen any evidence
that these things fix the problem either. Nevertheless, some women do
find comfort in using some of these preparations. They can make the
nipple feel better, which in turn stops breastfeeding from being
abandoned even if they don’t actually hasten the healing process.
Gently massaging some expressed milk onto the nipple at the end of a
feed appears to be as useful as anything else and has the added
advantage of being free, safe and non-allergenic.

If you do use something other than breastmilk on your nipples, be


careful. Some preparations make things worse. Avoid nipple sprays in
aerosol packs. They have ingredients which interfere with natural
lubrication and the normal protective barrier of the nipple which
prevents infection. They also contain a local anaesthetic which prevents
you having any idea from the level of discomfort whether the baby’s
position is right.

Cortisone, antifungal or antibiotic creams should not be used unless a


specific skin problem is diagnosed. Most sore nipples are related to the
way the baby takes the breast, not to skin conditions.

For most women with sore nipples, getting the position right, fresh air,
a little indirect sunlight plus massaging expressed milk into the nipple is
all that’s needed. Most nipples improve rapidly in the first few weeks.

For those who find feeding painful beyond the first few weeks there are
other things to try. Unfortunately all of these suggestions involve doing
things which might upset the supply and demand system of
breastfeeding and so cause more problems. These strategies include
such things as using a nipple shield, limiting feeds or temporarily
stopping breastfeeding from one or both breasts. Trying any of these
tactics is best done with help from an experienced person who will help
you get your baby back on the breast as quickly as possible. Such help,
however, is not always available, so please go ahead and try them
yourself if the thought of another breastfeed fills you with despair.

Limiting feeds and sucking time: It’s often difficult to separate hunger
from other aspects of baby behaviour when you’re breastfeeding for the
first time. Lots of normal, healthy, well-fed babies cry a lot, wake
frequently or have endless fussy, unsettled times when they don’t sleep.
It’s easy to see this behaviour as a breastfeeding problem and fall into a
pattern of endless, frequent feeds which seem to run into each other all day
and all night.

Very long sessions at the breast in the early weeks can contribute to sore
nipples. When babies are left on the breast for a long time and mothers are
tired the position can go wrong during the feed and nipples get hurt.
Twenty minutes or so is all babies need to get what they need and drain the
breast. If there are no nipple problems and you are happy, it’s fine to feed
as long and as often as you like, but if your nipples are sore or damaged,
try limiting your feeds to twenty minutes or less (depending on your baby)
and to about six every twenty-four hours until your nipples are feeling
better.

Temporarily stopping breastfeeding on one breast: Sometimes only one


nipple is sore. This may be the right one if you are right-handed or the left
one if you are left-handed because you are not as skilled at positioning
your baby with whichever arm and hand you don’t use as much.

Stopping feeding from the breast with the sore nipple and only feeding
from the other breast for twenty-four hours works well for some mothers.
Express the unused breast (by hand for comfort) if your baby is content on
one breast, or express enough for top-ups (by hand, or electric pump if
hand expressing is too tedious) from a bottle or cup if she needs extra. If
you can’t express enough for top-ups and your baby is not content with
one breast, use formula when necessary.
After twenty-four hours put your baby back to the breast with the sore
nipple, paying a lot of attention to your posture and her position. You may
like to try the gradual approach, where you put her back to the breast by
introducing one feed daily until you are fully breastfeeding again.

Temporarily stopping breastfeeding on both breasts: If both nipples are


very sore you might consider stopping breastfeeding for a short time—up
to a week—until they feel better. You will need to express every three to
four hours during the day to keep your supply going. Hand expressing is
often advised in this situation. If you can hand express easily go ahead, but
many women find it easier to use a hand pump or an electric pump. The
expressed milk and/or formula is given to your baby from a bottle or cup.
Complications can arise from doing this which you need to be aware of:

Your milk supply may decrease.

Expressing and feeding from a bottle or cup is tiring and time-


consuming.

Some babies are reluctant to go back to the breast after having bottles.

Some babies will not drink from a bottle and miss the sucking if they
drink from a cup, which makes them unsettled.

Nipple shields: A nipple shield is a soft rubber or silicone cap which fits
over the nipple and areola. Using a nipple shield helps some women to
breastfeed more comfortably until the nipple pain or discomfort gets
better. It sounds great but there are disadvantages to using a nipple shield:

A nipple shield forms a barrier between your breast and the baby’s
mouth so, as your breast doesn’t get as clear a message to make milk,
using a nipple shield can gradually reduce your supply.

When you become used to using a nipple shield it is often hard to stop
using it when you need to—that is, if your supply starts to decrease.

Babies beyond the newborn stage often object to nipple shields, so


starting to use them after about three weeks of age is not highly
successful.

Many women find feeding just as uncomfortable with a shield as


without.

But a number of mothers and babies do find a nipple shield very useful and
for them, using one stops breastfeeding from being abandoned.
Occasionally nipple shields are used successfully for months, sometimes
up to a year.

Choose a thin silicone shield.

Remember to keep following the guidelines for your posture and your
baby’s position when you feed.

Dry your nipples and areola gently. Lubricate the shield with a little
breast milk so it will stay in place. Hand express a little milk into the
nipple part of the shield before bringing your baby to the breast.

Let your baby suck longer than she normally does to compensate for
less stimulation to your breast.

Plan to use the nipple shield as a short-term strategy only—try some


feeds without it.

If possible, stay in touch with an adviser who can help you try some
feeds without the shield and make sure your milk is flowing.

On the positive side, nipples always get better, most in the first two to six
weeks. Think of all the wonderful benefits of breastmilk and try to see sore
nipples as a short-term problem in relation to the whole time you will be
breastfeeding. Support from family and friends and help and
encouragement from health workers do make an incredible difference.

Nipple problems are not inevitable but they are common. Everybody’s
pain threshold varies, so some women decide to wean. This is quite
understandable when life is a constant round of painful feeds which never
seem to improve and neither you nor your baby are happy.

Tongue tie and breastfeeding


Tongue tie refers to a condition where the baby’s tongue is attached to the
floor of the mouth rather than floating free. Mild tongue tie is very
common in newborn babies and does not cause breastfeeding problems.
Serious tongue tie is rare and more likely to be found in babies where such
a condition runs in the family. A tiny number of babies have a degree of
tongue tie that interferes with successful breastfeeding, resulting in
damaged nipples and low milk supply (the baby is unable to adequately
extend the tongue under the nipple). The incidence of this happening is
unknown and surgical release of the tongue for breastfeeding problems in
selected situations is occasionally performed. Case studies where this has
been performed report successful outcomes, but it should only be
considered after a full assessment of the baby and the breastfeeding
problems. (See also Tongue tie, chapter 10.)

Needle-sharp pain
A few women experience a piercing, stabbing breast pain which may
happen while the baby is sucking or in between feeds. Apart from these
spasmodic pains the breast feels fine. Needle-sharp pain is different to
mastitis or a blocked duct, where discomfort or pain is felt all the time.
Needle-sharp pain is possibly due to the release of oxytocin (which
tightens the muscles around the milk sacs in the breast). As it is spasmodic
and gradually fades it is something women learn to live with. It usually
disappears some time in the first three months. It’s possible for a woman to
experience it with one baby and not another. Needle-sharp pain is often
diagnosed as a fungal infection of the nipple or breast, but may not
respond to treatment either because there is no fungal infection or, rarely,
because the fungus is a species resistant to the anti-fungal medication
being used (see chapter 8).

Delays in getting breastfeeding started


Sometimes it is not possible for babies to go straight to the breast; for
example, premature babies or babies who have problems at birth and need
to be in an intensive care unit for a while. Many women and babies
breastfeed well after difficult beginnings. Your milk flow can be
stimulated and kept going by massage and expressing until your baby is
able to take all her feeds from the breast. Here’s a guide:

It’s a good idea to start expressing as soon as possible after birth but
don’t panic if there are delays. If you are very tired, distressed or in any
discomfort, wait until you feel you can handle learning how to express.
When you are ready, a midwife can show you how to hand express.
Hand expressing is best to begin with. After the milk is flowing a hand
pump or electric pump can be used. Keep asking for help after you are
shown what to do if your technique doesn’t seem to be working. See
How to express and store breastmilk, chapter 8.

Regardless of the amount of milk you express, don’t give up. In the
beginning you might only express a few drops of colostrum—don’t
throw it away, even tiny amounts are good for your baby to have. Once
the mature milk is flowing, try not to compare how much you express
with how much someone else expresses. Remember, babies stimulate
and remove the milk much more efficiently than expressing does; once
your baby is sucking regularly your supply will build up.

The transition from tube feeding or bottle feeding to breastfeeding is a


challenge. Many premature or sick babies take the breast well and suck
strongly, others take quite a long time to learn what to do. When this
happens, expert help from the midwives and lactation consultants who
work in maternity hospitals is needed for a while.

FOR MORE INFORMATION


Chapter 8: Breastfeeding Your Baby After the First Two Weeks (Candida albicans [thrush])

Chapter 10: Early Worries and Queries (blue around baby’s mouth)

Chapter 13: Growth and Development (rooting reflex)

Chapter 14: Sleeping and Waking in the First Six Months (settling techniques)

Chapter 15: The Crying Baby (wind)

Chapter 16: For Parents (contraception and breastfeeding,


health professionals you may come in contact with)

FURTHER READING
The Politics of Breastfeeding, Gabrielle Palmer, Nutritionist and Campaigner, Pinter & Martin,
3rd edition, 2009. A classic, this book is a fascinating look at the growth of artificial feeding in
the 20th century. Read it with an open mind for a new perspective on infant feeding.
Breastfeeding Matters, Maureen Minchin, Alma Publications, 4th edition, 1998. A breastfeeding
classic. As with the above book, much of the information gives a fresh perspective to many of the
dilemmas surrounding infant feeding.

Breastfeeding with Confidence: A do-it-yourself guide, Sue Cox, Meadowbrook, 2006. A detailed
guide for getting breastfeeding started and established by an experienced hands-on lactation
consultant which, if you are having early difficulties, you may like to refer to in addition to Baby
Love.
7

Bottle Feeding—The First Two


Weeks
Previous chapter | Contents | Next chapter
Breastfeeding and formula feeding are very emotional issues for lots of
reasons. There may be feelings of disappointment when breastfeeding
doesn’t work out and a sense of loss or even anger that something
promoted as easy and pleasant turned out to be problematic and stressful.

Women usually wean because breastfeeding problems arise which either


seem impossible to solve or are impossible to solve any other way. See
here for more on weaning.

It’s as important for women who are bottle feeding to have accurate,
detailed information about formula feeding as it is for women who are
breastfeeding.

Bottle feeding babies is so much a part of modern living it is very much


taken for granted. Safe bottle feeding, however, depends on a healthy
water supply, enough money to meet the costs, refrigeration, clean
surroundings and satisfactory arrangements for cleaning and storing
equipment. Parents without literacy skills or parents who do not speak
English need extra help to make sure their bottle feeding is done safely.

If you are unsure of whether you want to breastfeed or not, remember that
weaning and formula feeding is an option at any time. Breastfeeding isn’t,
and once you start to wean it can be difficult to go back to breastfeeding.

When babies are not breastfed or have a combination of breastmilk and


formula it is very important to make sure that the substitute milk they are
receiving meets as much of the baby’s nutritional needs as possible. It is
also important to make sure it is mixed, stored and handled properly so the
baby does not get sick.

What’s in formula?
It’s good to have an idea of what’s in formula so you know what you are
giving your baby.

Commercial artificial milk for babies has been around since 1900. Early
attempts to mimic breastmilk were disastrous. Apart from no one having
any idea what the ingredients should be, poor bottle and teat design,
unhygienic practices and surroundings and unhealthy water all contributed
to a high infant mortality rate. During last century general improvements
in the standard of living, better-designed bottles and teats and the growing
realisation of the complexity of breastmilk has helped make formula
feeding safer.

Infant formula is made from either cow’s milk, goat’s milk or soya beans.
Formula made from cow’s milk has been around the longest, suits most
babies and is considered to be the safest. The cow’s milk, goat’s milk or
soy liquid is altered to overcome the dangers of giving babies these
substances unmodified. Formula is being constantly changed to try to get
nutritional profiles closer to that of breastmilk.

Infant Formula Standard


Food Standards Australia New Zealand is responsible for the Infant
Formula Standard, which consists of an acceptable range of
macronutrients and micronutrients. All infant formulas sold in Australia
must meet the Standard.

Choosing a formula
All infant formula varies but there is no ‘best’ formula. The variations
between brands and types of formula mostly centre on the balance and
types of fat, protein and carbohydrates that are used; however, there are
ingredients that are found in some products and not others.

‘Standard from birth’ formula


A cow’s milk formula labelled ‘standard from birth’ is the recommended
first choice and can be used for the whole of the first year. Cost is as good
a criterion as any when selecting a brand—price and whether formulas are
sold in supermarkets or pharmacies bear no relation to their quality or
nutritional value.

Follow-on ‘milk’
Follow-on ‘milk’—designed for babies aged six to twelve months—has no
advantages over ‘standard from birth’ formula unless it is cheaper.
However, as it is higher in protein and electrolytes it should not be given
to babies under six months. This preparation is not necessary for most
babies as, ideally, extra protein in the second six months comes via food
from a spoon. By twelve months babies should be offered a variety of
foods including cow’s milk and as soon as possible be drinking both milk
and water from a cup.

Features of ‘standard from birth’ formula made from


cow’s milk

Protein:
Human milk protein consists of 65 per cent whey (‘soft’ protein) and 35
per cent casein (‘hard’ protein); however, cow’s milk contains only 18 per
cent whey and 82 per cent casein. Cow’s milk protein in formula is altered
so the proportion of whey to casein is like that of human milk. Most
formula for use from birth has a proportion of 60 per cent whey/40 per
cent casein.

Lactose:
Lactose is the carbohydrate found in mammal’s milk. Human milk has a
higher lactose content than cow’s milk, so extra lactose is added to
formula. The carbohydrate in standard formulas is 100 per cent lactose; in
‘anti-reflux’ formula it is maltodextrin; in soy and low-lactose formulas
carbohydrates come in the forms of corn starch, corn-syrup solids, dried
glucose syrup or sucrose.

Fat:
Over half the calories in breastmilk and formula are derived from fat. The
fat in cow’s milk is different to that in human milk, so formula also
contains a blend of vegetable oils (palm, coconut, oleic safflower and soy)
to get a fatty acid profile more like breastmilk.

Formula is supplemented with vitamins, minerals and trace elements.

New ingredients in formula


In Australia the following ingredients have been added to formula at
various times over the last decade:

[Alpha]-Lactalbumin (bovine):
[Alpha]-lactalbumin is the major protein in breastmilk. Apart from its
nutritional value it has antibacterial and immune-boosting properties that
protect against infection, and is a major source of tryptophan, which plays
a part in neurological development. Cow’s milk also contains [alpha]-
lactalbumin and some formulas are now supplemented with bovine (cow’s
milk) [alpha]-lactalbumin.

Nucleotides:
Nucleotides are the basic building blocks of RNA and DNA, and are
important in periods of rapid growth. They are found in higher amounts in
human milk than in cow’s milk and are thought to enhance the immune
system, improve iron absorption and help maintain ‘good’ bacteria
populations. Nucleotides used in formula are purified from plant yeast.

Long-chain polyunsaturated fatty acids (LCPUFAs):


LCPUFAs are essential fatty acids obtained through the diet. Breastmilk
has many unique LCPUFAs, among them DHA (docosahexaenoic acid)
and AA (arachidonic acid), which contribute to cognitive and visual
development. Some ‘standard from birth’ formulas contain DHA and AA
extracted from various sources such as fish oil, egg yolk lipid, fungus and
marine algae.

Protobiotics:
Probiotics are live, active, ‘good’ bacteria such as are found naturally in
yoghurt and fermented milk. Unlike cow’s milk, breastmilk contains a
high proportion of non-digestible sugars that feed ‘good’ bacteria in the
gut. These bacteria are important in immune development as well as
providing a barrier to intestinal infections. The probiotics organisms found
in formula are similar to those in the guts of breastfed babies, but not the
same.
Things you need to know about new ingredients
None of these new ingredients have been used for long enough or have
been tested in sufficient depth to confirm their claimed benefits.

It remains uncertain whether they function in a similar way to their


counterparts in breastmilk.

Comparisons between formulas containing various combinations of


these ingredients and formulas that contain none of them are limited
and so far have not yielded anything conclusive.

If there is conclusive evidence that a formula ingredient is essential


and/or beneficial for baby health—for example, iron—then it is
mandatory for it to be added to all brands and types of formulas. As
there is not enough accumulated evidence to show that the above
ingredients are essential, their addition to all formulas is not mandatory.
This explains the confusing situation at the moment where the inclusion
of all or some of them varies between formulas. To find out, read the
labels carefully.

While there is no conclusive proof of their benefits nor has there been
any proof of harm for healthy, full-term babies.

Formulas with these ingredients are more expensive. It can be a highly


emotional time for mothers when their breastfeeding doesn’t work out
and they have to turn to formula. Much of formula advertising plays on
these emotions by subtly suggesting that the more expensive formulas
are superior substitutes for breastmilk than the cheaper varieties. Bear
in mind if you use a formula with one or more of the latest ingredients
listed above you are paying extra for a potential, not a proven, benefit.
There is no formula on the market that is ‘closest to breastmilk’ even if
advertising on the side of the tin gives you the impression this might be
the case.

Specialised formulas
These formulas (described below) are not advantageous for most babies
and may cause problems. Using one of these formulas or changing to one
from a standard cow’s milk formula because your baby is unsettled, a
fussy feeder, a happy regurgitator (vomiter) or has a rash is unlikely to
make any difference.

Hypoallergenic (HA) formula


The cow’s milk protein in hypoallergenic formula is partially artificially
broken down with the aim of minimising food allergy and intolerance.
Research from the CSIRO suggests that whole-milk proteins broken down
naturally by digestion may play a significant role in growth, preventing
infections and developing immunity. Whole breastmilk proteins are
optimum but when breastmilk is unavailable a standard cow’s milk
formula is preferable to HA formula. Recent studies at the Murdoch
Childrens Research Institute (2011) have found that HA formula does not
reduce allergy risk in susceptible children. Nevertheless, The Australasian
Society of Clinical Immunology and Allergy still recommends HA
formula for babies at high risk of allergy until more studies are done and
reported. See also Food allergies and food intolerance in chapter 18.

Soy formula
There is no role for soy formula any more and it is anticipated that it will
eventually be phased out. There have long been concerns about nutritional
and other problems with its use. These include the presence of plant
hormones and high levels of aluminium. Some research has shown a
higher incidence of infection in babies fed on soy formula. Soy formula
does not help babies with ‘colic’, excessive crying or sleep problems.
Babies at high risk of allergy (as per HA formula) should, ideally, be
breastfed, or seek professional advice regarding which formula to use.
Formula-fed babies with a proven diagnosis of lactose intolerance can
usually be given a low-lactose cow’s milk formula.

Low-lactose formula
Low-lactose formula is a cow’s milk formula with reduced levels of
lactose, used for babies with lactose intolerance (see chapter 15). The most
appropriate use of this product is in older formula-fed babies recovering
from gastroenteritis.

‘Anti-reflux’ (AR) thickened formula


This formula aims to lessen the amounts of milk regurgitating babies bring
up (see chapter 10), and is primarily designed to ease parent anxiety. There
is rarely a medical requirement for ‘anti-reflux’ formula.

Goat’s milk formula


There are no benefits or medical indications for using this formula.

Genetically modified (GM) formula


The use of genetically modified components in formula has not been
prohibited by government regulations. The constituents most likely to be
affected are those of soybean origin, but any formula may contain GM
protein as other constituents derived from soybean products, such as
lecithin, are used in cow’s milk formula. For information, call formula
hotlines.

Safe bottle feeding


If you start breastfeeding and then decide to wean, talk to your midwife or,
if you have left hospital, your child and family health nurse about the best
way to do this. Gradual weaning is much more comfortable than stopping
breastfeeding suddenly. Unless there’s an emergency there’s no need to do
anything quickly. Medication is no longer used owing to risks associated
with its use.

A word about ‘sterilisation’


Sterilisation is somewhat of a nonsense word we use in relation to caring
for babies’ feeding utensils at home. Sterilisation is an operation theatre
technique where the aim is a complete absence of all micro-organisms.
This is not only an impossible feat in the average kitchen but not necessary
for the baby’s wellbeing.

Cleanliness is next to godliness and is a vital component of bottle feeding


and expressing and storing breastmilk. Thorough cleaning and disinfecting
of equipment as well as close attention to hand washing to make sure any
harmful bacteria are destroyed is what is required.
Basic equipment

4–6 large bottles


A large variety is available. Bottles are made of clear glass (heavy,
breakable) or polycarbonate (rigid plastic, light, unbreakable). Concerns
were raised in 2008 in Canada about the chemical Bisphenol-A (BPA)
used in the production of polycarbonate plastic. Studies on animals suggest
that BPA can affect neural development and behaviour when animals are
exposed to this chemical in early life. Canadian scientists involved in the
study of BPA do not believe, at this time, that there is a link between BPA
and obesity and breast and prostate cancer, as has been claimed by some
sources.

While BPA used in the manufacture of bottles and cups is a concern in


relation to babies and toddlers under eighteen months, exposure levels are
below those that could cause health effects, so don’t panic. There are also
no adverse effects reported as a direct consequence from the use of baby
bottles/cups with BPA in the past. Nevertheless since exposure rates are
close to levels where potential ill-effects could occur in the vulnerable
population of babies and toddlers, it is advisable to avoid or reduce their
exposure to BPA. Some governments are looking at banning the
import/manufacture of polycarbonate baby bottles and cups.

Here are some steps you can take to minimise the very small risks of BPA:

Choose BPA-free products. Glass is the obvious alternative but as it is


heavy and breakable it is nowhere near as convenient. Several
alternatives to polycarbonate exist, and more will be arriving on the
market as the word gets out. Polycarbonate products usually have a 7 in
the centre of a recycling symbol on the base, often with a PC beside it.

If you are using polycarbonate bottles do not put boiling water into the
bottles as very hot water causes BPA to migrate out of the bottle at a
much higher rate. Water should be boiled then cooled in a non-BPA
container before transferring it to baby bottles.

Bottles can be disinfected in the normal way and washed in


dishwashers. Make sure the bottles have cooled down before you use
them.
When heating made-up formula aim for room temperature, no hotter (in
fact, many babies don’t mind cold milk). Heating polycarbonate bottles
in bottle warmers or microwave ovens is risky as it’s too easy to overdo
it and, in the case of bottle warmers, there’s a risk of contaminated milk
if the bottle is left in the warmer for too long. (I don’t recommend either
heating method regardless of the type of bottles).

Other bottle tips


Many bottle manufacturers offer a range of different shaped bottles, bottles
with ‘handles’ and bottles with anti-colic devices. These are all marketing
ploys, not science. Decorations and odd-shaped bottles make bottles hard
to clean. There’s nothing clever about encouraging babies to clutch at
handles and ‘feed themselves’, and strange shapes do not prevent ‘wind’ or
‘colic’ so stick to plain bottles.

Several teats
Teats are either made from rubber, also called latex (brown coloured) or
silicone (clear coloured).

Latex teats cost less, are softer and preferred by some babies, and there is
the issue of nitrosamines to consider (see chapter 5). Companies that
manufacture latex teats manufacture silicone teats as well, so if the thought
of nitrosamines bothers you, try silicone. Silicone teats are harder and cost
more, but last longer. Less elasticity means they are liable to tear and that
bits can break off, which makes them a possible choking hazard. Inspect
them frequently by holding them up to the light. If they look faulty throw
them away.

Shape variations have no particular advantages (as in orthodontic teats)


unless your baby prefers that shape. There are no superior bottles and teats.
Some babies may prefer one system to another but, in general, constantly
changing bottles and teats is a needless expense.

A knife for levelling the powder

A bottle brush to clean the bottles and teats

Disinfecting equipment
It’s advisable to disinfect bottle feeding equipment until your baby’s
immune system is mature enough to protect her against nasties. If you live
where there is clean water, clean surroundings and refrigeration you do not
need to keep disinfecting after your baby is six months old.

Rinse everything in cold water straight after use. Before disinfecting wash
carefully in hot, soapy water. Rinse well again. Washing is important—
disinfecting doesn’t work if old milk is left on bottles and teats. Give teats
and dummies an extra good scrub.

When you disinfect choose between:

Boiling
Place utensils in a large saucepan.

Cover with water.

Bring to boil and boil for five minutes, adding teats for the last two
minutes.

Please take care when boiling equipment to avoid scalding yourself or


children. One way to reduce this risk is to allow the equipment to cool in
the saucepan until it is hand hot before moving it and, as often as possible,
to do your boiling when the children are not around.

Store equipment you are not going to use straight away in a clean
container in the fridge.

Boil clean equipment every twenty-four hours.

Disinfecting using chemicals


A chemical sterilant is an anti-bacterial solution which comes in liquid or
tablet form. The chemical used is a bleach which is diluted with water to a
safe solution so it will not harm your baby although it does kill harmful
bacteria.

Follow the manufacturer’s instructions carefully when you make up the


solution. The instructions will tell you how to dilute the tablets or liquid.
After a twenty-four hour period discard the used solution, thoroughly
scrub the container and equipment in warm, soapy water and renew the
solution.

Make sure all your equipment is plastic or glass, not metal, as metal
corrodes when left in chemical sterilant.

Completely submerge everything and leave it all in the solution for the
recommended time before using. Equipment may be left in the solution
indefinitely when it is not in use. Store the concentrate and solution well
out of the reach of children.

Steam sterilisers
Steam sterilisers are automatic units which raise the temperature quickly to
the range which kills harmful bacteria. To use, place clean equipment into
the unit, add water according to the manufacturer’s instructions and switch
on. The unit switches itself off when the job is done.

Microwave steam sterilisers


Sterilising units for use in microwave ovens have recently appeared on the
market. They are suitable to use as long as the manufacturer’s instructions
are followed.

Using formula
When formula powder or liquid formula is combined with water, all of
your baby’s food and drink needs are being met. The finished product is
only as good as the manufacturer claims if the formula is reconstituted
properly.

Here’s some important information:


The strength of formula is designed to remain constant so you never
have to strengthen or weaken the mixture. As your baby grows it is the
amount that increases, not the strength.
Always use the scoop that comes with the particular brand of formula
you are using. Scoops are not interchangeable between brands. Never
use half scoops of powder.

If you use concentrated liquid formula, use equal proportions of


formula and water unless otherwise stated.

If you change brands of powdered formula remember to check the


number of scoops per ml of boiled water. The proportions vary between
brands.

When in doubt, check with a pharmacist, child and family health nurse
or doctor.

Making your baby’s feeds


Prolonged boiling of water has been found to be unnecessary when making
up formula. To prepare water for making up formula, the electric jug
should be emptied, refilled with tap water prior to use and brought to the
boil. Jugs with no automatic ‘cut off’ should be switched off within thirty
seconds of boiling.

Always allow the water to cool before adding the powder or liquid.

The preferred and safest method for making formula at home is ‘in the
bottle’, one at a time, because:

It reduces contamination.

It reduces the amount of equipment needed.

It reduces the possibility of mistakes when mixing the water and scoops
of formula—if a mistake is made it is only for one feed.

If you prefer preparing formula for a twenty-four-hour period it is safer


to prepare five to seven individual bottles than prepare the formula in a
jug.

To prepare the bottles


Measure the amount of cooled, boiled water required into individual
bottles.

Using the scoop from the formula tin, measure the required number of
scoops into the bottles. Use a knife to level off each scoop.

Seal the bottle with a cap and disc and shake gently to mix it.

Store all made-up formula in the centre back of the fridge where it is
coldest, not in the door where it is warmer.

Throw out any formula not used after twenty-four hours.

To prepare formula in a jug


Many parents do prepare formula in a jug for use over a twenty-four hour
period. This is acceptable when refrigeration is available and as long as the
correct proportions (scoops to ml of water) are calculated.

Double-check the proportions needed for twenty-four hours with


someone else if you are unsure. If there is no one to ask, it is better to
make up the formula one feed at a time, in the bottle.

Measure the cooled, boiled water into a measuring jug with clear levels
marked on the side.

Using the scoop from the formula tin, measure the required number of
scoops into the measuring jug. Use a knife to level off each scoop.
Avoid distractions when counting the scoops. Ignore or turn your phone
off and turn off the radio. Have pen and paper handy to jot down the
number of scoops you are up to if you are interrupted.

Store the mixture in the centre of the back of the refrigerator in either
the covered jug or individual feeding bottles.

Safety tips
Always wash your hands and work surfaces before preparing formula.

Put formula straight into the fridge as soon as it is made.


Storing half-empty bottles for future use is risky as they quickly
become contaminated once they have been heated and sucked on.
Throw away the contents of used bottles after an hour.

Check the expiry date on tins of formula and discard them if they are
out of date.

Discard any opened tin of formula after one month.

The safest way to transport formula is to take the cooled, boiled water
and the powdered formula in separate containers and mix them when
needed. If transporting prepared formula or expressed breastmilk it
must be icy cold when you leave home and carried in a thermal baby
bottle pack to keep it cold. If you cannot heat the bottle when you reach
your destination it’s quite all right to give it as it is.

Never leave bottles warming for more than about ten minutes. Bacteria
multiply rapidly in warm milk—this is a common cause of diarrhoea.

Safe bottle feeding steps

Giving the bottle


Giving babies cold formula is not at all harmful and at times may be safer
than trying to heat it quickly (for example in a microwave oven in a busy
restaurant). Warming to room temperature is the generally acceptable way
to give it but if your baby is flexible about the temperature of her milk it
does make it easier for you when you are out and about.

Standing the bottle in warm to hot water is the traditional way (and
remains the safest) of heating bottles. Bottle warmers are convenient and
safe as long as they have a thermostat control, but remember not to leave
bottles warming in them longer than ten minutes. Microwaves are not
recommended because of the safety aspects—babies end up with burnt
mouths because the temperature of the milk is misjudged or because of hot
spots in the milk.

Teats and getting the formula to flow right


Initially it’s often tricky getting the milk to flow just right. You may find
you have to try several types of teat before your baby is happy. To test the
flow, hold the bottle upside down when it is filled with the milk mixture at
room temperature-the milk should drip steadily. If you have to shake it
vigorously it is too slow and your baby will go to sleep before she drinks
what she needs. The milk should drip easily at a steady rate without
pouring out in a great stream. A little leakage at the corner of her mouth
while she feeds is nothing to worry about; as she gets older this will stop.
If you have difficulty finding the perfect teat, always go for a faster teat
rather than a slow one.
Feed time
Before giving the bottle, always check the temperature of the feed by
shaking a little from the teat onto the inside of your wrist.

Make yourself comfortable and cuddle your baby close to you, holding her
gently and firmly. If she feels secure and cosy the feeding will be more
enjoyable for you both.

Put the teat against her lips. She will open her mouth and start to suck.
Keep the neck of the bottle at an angle so the neck of the bottle is filled
with the milk mixture. When she stops sucking strongly or when she
drinks about half the milk, gently remove the bottle and see if she wants to
burp (see burping, chapter 6).

If she has gone to sleep, unwrap her, put her over your shoulder, rub her
back and stroke her head, legs and tummy to wake her up. Wait until she is
in an alert state before offering her the rest of the milk.

How long does it take to drink the bottle?


This varies tremendously between babies but roughly it takes between ten
and thirty minutes. Less than ten is too fast when they are young as they
are not getting all the sucking time they need to feel contented. More than
thirty is too slow for most babies and means they are probably falling off
to sleep before drinking quite enough. Adjust the flow as best you can to
suit your baby; either by screwing the plastic attachment on the neck of the
bottle tighter or by trying different teats. As babies grow older they take a
lot less time to drink their bottles.

Safety tip
It is dangerous to ‘prop’ a bottle and walk away, leaving baby to manage
on her own. The milk may flow too quickly and cause her to splutter or
even choke so she can’t breathe. As well, babies who feed a lot on their
own are at greater risk of ear infections. Babies need to be held, cuddled
and talked to when they are fed.
Bottle feeding twins
When one baby is asleep and one awake, you can nurse and feed. When
they are both awake and hungry at the same time change them both, give
each one a cuddle, then sit them in either portable baby chairs or propped
up together on a lounge. Sit in front of them and feed one baby with one
hand and one with the other. Make sure you are comfortable and not
straining your back, neck or arms while you feed.

Of course, hold them for feeds whenever possible, but when it’s not, sit
them close together and chat away while you give them their bottles. Don’t
worry if one drinks more than the other—twins are like any other two
individual babies and may drink different amounts.

Bottle feeding premature babies


When premature babies are very young and/or sick the volume of milk is
restricted and monitored closely, but by the time they go home they are
ready to follow the same guidelines as for full-term babies. Premature
babies do better with faster teats or teats that have a cross-cut rather than a
hole.

How much milk?


Bottle fed babies, like breastfed babies, drink variable amounts and may
have some feeds close together and others further apart. Your baby needs
150–200ml per kilo of body weight per day until she is three months old,
then 120ml per kilo of body weight. These amounts are divided into six to
seven feeds every twenty-four hours and offered on demand.

Please remember there are many individual variations on these amounts


and number of bottles. Information about the quantity for age on formula
tins is a guide only and may not necessarily suit your baby. Many babies
never drink the ‘required amount’ for their age and size, others need more.
Plenty of wet nappies, consistent weight gains that are not excessive and a
thriving, active baby mean all is well.
Age Weight Volume per feed Feeds per 24 hours

Birth–1 week 30–60ml 6–8 bottles

1–4 weeks 150ml/kg of body weight 60–120ml 5–8 bottles

4–8 weeks 150ml/kg of body weight 120–150ml 5–8 bottles

8–12 weeks 150ml/kg of body weight 150–210ml 5–7 bottles

3–6 months 150–240ml 4–5 bottles

6–9 months 120–180ml 2–4 bottles (or from a cup) 3 meals

9–12 months 120–180ml 2–3 bottles (or from a cup) 3 meals

FOR MORE INFORMATION


Chapter 9: Bottle Feeding Your Baby After the First Two Weeks (early weaning)

Chapter 14: Sleeping and Waking in the First Six Months

Chapter 15: The Crying Baby (protein intolerance, lactose intolerance, ‘wind’, ‘colic’ and the
relationship of formula)

Chapter 24: Feeding Your Baby (introduction of whole cow’s milk)


8

Breastfeeding—After the First


Two Weeks
Previous chapter | Contents | Next chapter
Your diet
Sometimes so much is made of ‘the mother’s diet’ that women choose to
use formula because they incorrectly believe they have to make
unacceptable changes to their diet. Breastfeeding is a body function and
like any body function works better if you are well nourished. Eating well
helps you enjoy your breastfeeding and your baby more and helps your
body adjust to the extra work.

On the other hand, women who live where there is never enough food still
manage to breastfeed—so even when diets fall short of the ideal your baby
will still thrive. It is only in extreme situations that the mother’s diet
affects the quantity and quality of breastmilk. After all, breastfeeding
ensured our survival 40,000+ years ago when humans had very little in the
way of food reserves. Let’s dispel a few myths:

You do not have to eat enough for two. Women’s bodies seem to
conserve energy when they breastfeed. As well, fat stores laid down
during pregnancy provide extra energy. Regular meals are the best way
to go, so try not to skip meals. Alternatively, frequent snacks
throughout the day might suit you better until you are used to your new
life and worked out who is going to prepare the meals!

You do not have to drink heaps of any sort of fluid to ‘make milk’,
including cow’s milk. You will notice that you are often thirsty when
you feed, so drink what you need to, to relieve your thirst.

There is no food or beverage that ‘makes more milk’.

Baby rashes, baby poo, baby crying and all the strange and wonderful
things babies do in the first three months are rarely anything to do with
what their mothers are eating. Eat your normal diet, experiment with
food you don’t normally eat—if you think it upsets your baby don’t eat
it again for a while. Restricting your diet while breastfeeding (avoiding
peanuts, for example) to prevent sensitisation by the baby and thus
future allergy problems is no longer recommended. See chapter 18 for
more on food allergy and intolerance.
Take no notice when well-meaning people around you suggest
something you’re eating is upsetting your baby or giving her a rash.
Think about women from other cultures who have been eating ‘spicy’
food and breastfeeding for thousands of years as you enjoy a chocolate
after dinner.

Feeding patterns
Breastfeeding is not like bottle feeding, where the volume taken per feed
increases and the number of bottles every twenty-four hours decreases as
the baby gets older. Most women need to keep breastfeeding six times or
more every twenty-four hours to maintain the milk supply; however, the
sucking time usually decreases, often quite dramatically, between six
weeks and three months. Breastfeeding around this time becomes easy,
often sensual and pleasurable without having to worry any more about the
all-important ‘position’. This pattern of breastfeeding continues until a
reasonable amount of food from a spoon is going down (between six and
eight months), at which time if you want to or if your baby decides to, you
can start to decrease the number of breastfeeds. For breastfeeding tips on
what to do if your baby sleeps all night from a young age see chapter 14.

How to express and store breastmilk


Expressing isn’t an essential part of breastfeeding, but being able to
express your breastmilk is a very handy skill for a few different reasons,
for example:

When breastfeeding is delayed after birth.

To relieve engorged breasts in the early days. Hand expressing helps


soften the nipple and areola so it’s easier for your baby to get a good
mouthful of breast.

To remove a little milk before feeding if your supply is abundant and


your baby is being overwhelmed by a sudden rush of milk.

For your comfort if your baby refuses one breast or goes through a
phase of breast refusal. (See Breast refusal, chapter 8.)

To remove a little milk if your breasts still feel lumpy and


uncomfortable after a feed.

For times when you won’t be around for a feed—study, returning to


paid work or a night out.

Learning how to express can be messy and tedious and, like whistling or
riding a bike, some women find it easier than others. Many women
breastfeed and never express. If you can’t express much milk it does not
mean you have a low supply. Your baby can stimulate and remove the
milk much more effectively than you can. Whichever expressing method
you use, you will find switching breasts frequently increases the amount
you express and relieves your fingers (if hand expressing) and arms.
Switching frequently also lessens the chance of hurting your breasts by
trying to express milk after the flow has slowed down.

N.B.: Expressing is different from breastfeeding. When breastfeeding, the


baby is not rapidly swapped from one breast to another.

Expressing can be done by hand expressing, by using a hand pump or by


using an electric pump.

Hand expressing
There are lots of good things about hand expressing:

It’s convenient and free.

Skin-to-skin contact stimulates milk production more efficiently and


makes the let-down easier.

Hand expressing seems awkward and slow in the beginning, but many
women find it becomes easy and efficient with a little practice. When you
express, the aim is to stimulate the let-down reflex, then, by putting
pressure where the milk is stored (under the areola), removing the milk.
Gentle pressure is applied to the areola, not the nipple or the breast.
Wash your hands before you start. There are a few different ways of hand
expressing and once you know the basics you will probably find your own
style.

Here’s one way. Think of expressing as two separate actions.

(A) Assisting the let-down: Support one breast from underneath with the
opposite hand. Massage your breast gently but firmly with your free hand.
Use a circular motion similar to that recommended for self breast
examination, paying particular attention to the underneath part and the part
along the side of your breast near your arm as this is where most of the
glands where the milk is made are located. After massaging, stroke the
breast with a feather-light touch using all your fingers. Stroke from the top
of your breast to your nipple.

This technique for helping the let-down is used for whichever method of
expressing you are using.

If there is going to be a long time before your baby can go to the breast
because she is premature or sick and you are expressing every three hours
or so, thinking about your baby and looking at her photo can help stimulate
your milk. A quiet place and some relaxation techniques help too.

(B) Expressing the milk: Until you get used to hand expressing don’t
worry about collecting the milk. Practising in the shower or bath is
relaxing, or simply squirt the milk into a towel.

Support your breast in one hand. Place your thumb and first two fingers of
the other hand on the edge of the areola—the thumb is above, the fingers
below. When hand expressing the aim is to move the milk along the ducts
in the breast and empty the stored milk under the areola so you use your
fingers in the same way a baby sucks.

Here’s the tricky part. Push your thumb and finger into your breast then
compress your thumb and fingers together. Repeat the action. Push in,
compress, push in, compress. Rotate your fingers and thumb around the
areola to express all the stored milk. Swap hands when the position of your
thumb and fingers becomes awkward.

Avoid pinching or squeezing the nipple as this closes up the milk ducts
and the milk won’t flow—it also hurts!

Until you are used to hand expressing it’s easier to use a clean wide bowl
held between your legs or on a low table to catch the milk so both your
hands are free; leaning forward means gravity helps the let-down. Have a
towel handy. Later, when you can do it better, hold a clean container near
your breast and express into it.

Expressing milk for storage takes twenty to thirty minutes in the early
weeks. After your milk is flowing well it takes less time. Try expressing
each breast for five to seven minutes, three to five minutes then two to
three minutes. These times are just a guide—when the milk dwindles,
change breasts. Never try and force milk out when it’s not coming easily.
Handle your breasts gently, as putting pressure on them can cause bruising
and discomfort.

Expressing with a hand or electric pump


Some women find it easier to express using hand or electric pumps. There
are now many types of hand, battery-operated and electric pumps
available. Breast pumps have improved out of sight in relation to
efficiency, comfort and ease of use but there are still some duds out there
so do some research before you buy. Ask your friends for
recommendations, the ABA or try this website devoted to breast pump
research—www.babylovesyourmilk.com It is American, however, many
of the brands are available here.

Hand pumps
Hand pumps are more economical to buy but more tiring to use if you are
expressing regularly several times a day for any length of time. The
technique for using a hand pump is similar to hand expressing. Use the
same massage and stroking techniques to stimulate the let-down, arrange
for privacy and go slowly and gently.

Electric and battery-operated pumps


Battery-operated pumps suit some people as they are easier to use than
hand pumps and cheaper than electric pumps. Do your research before
buying (see above). Electric pumps are more efficient and less tiring when
expressed milk is needed for any length of time. Electric pumps are also
useful occasionally to increase the milk supply. Electric pumps are
expensive to buy and may be hired to use at home from pharmacies,
Australian Breastfeeding Association (ABA) or specialist retail outlets.
ABA only has limited supplies and gives priority to mothers with sick or
premature babies. If you don’t have anyone to show you how to use an
electric pump, follow the instructions for use carefully to avoid infection
or getting bugs in your milk.

When is the best time to express?


When to express depends on why you are expressing:

When your baby can’t go to the breast for a long time. If your baby is
sick or premature, most of the time you will need to express about eight
times every twenty-four hours. You can be flexible about the length of
time in between—expressing does not have to be done every three or
four hours. The more you express, the more milk you will make;
however, it is also important that you look after yourself as well. Six
hours of undisturbed sleep at night is good for you.

Returning to full-time paid work. (See Paid work and breastfeeding,


chapter 18.)

For times when you won’t be there—regular absences for study, part-
time paid work or voluntary work or for occasional absences.

While they are fully breastfeeding as well, most women find it difficult to
express enough for one feed in one expressing session, so don’t be
surprised if it takes several days to express enough for one feed. It is quite
normal to only be able to express 30–40ml a day. Think ahead, express
daily and store the expressed milk in the freezer until you have enough so
you are not under pressure to produce enough milk for a feed on Saturday
morning before going out on Saturday night—very stressful! If you expect
to have regular absences it is a good idea to express and freeze milk daily.

The best times to do this are:

After a feed when there is likely to be extra milk available. Early


morning feeds after you and your baby have slept are often a good time.

In between feeds when you are pretty sure your baby is going to sleep
for three or more hours—try pumping after she has been asleep for two
hours.

Any time when your supply is abundant and your baby fills up on one
breast. Feed on one breast and express the other.

How much to express?


A guide is 150ml per kilo of body weight for each twenty-four hour period
when babies are under three months. This may be anything from 60ml to
240ml depending on your baby’s age and size. When it’s for an occasional
bottle a rough estimate is fine.

For example:

0–4 weeks: 60–120ml

0–8 weeks: 120–150ml

8–12 weeks: 150–240ml

If for some reason all your baby’s feeds are going to be expressed
breastmilk given in a bottle, please refer to the section on bottle feeding for
more information. When expressing for occasional feeds, be kind to your
babysitter and leave a little extra when you can, as babies can often drink
faster from a bottle than the breast then look around for more.

Storing breastmilk
Breastmilk can be stored in plastic containers, plastic or glass bottles or
disposable, sealable plastic bags. Plastic bags take up much less space but
need a label with volume as well as the date. Double plastic bags are more
secure. If most of your baby’s feeds are to be given in a bottle, avoid
freezing her milk in a glass container as there is some loss of antibodies
when breastmilk is stored in glass.

Wash the containers, rinse and disinfect them. After you express the milk,
pour it into the prepared container and put it in the fridge. If you intend to
freeze the milk, wait until it is cold then pour it into another container in
the freezer. Each time you express fresh milk, wait until it is cold and add
it to your frozen supply until you have enough for a feed, then start a new
lot. It’s quite all right to keep adding fresh milk to frozen milk as long as
you cool it first. This avoids lots of little packets of frozen breastmilk all
over the freezer. Freezing breastmilk in ice cube trays is not practical once
your baby is old enough to drink substantial amounts. Apart from that, a
cube might go into your gin and tonic by mistake!

Storage of breastmilk for home use


Expressed breastmilk looks quite interesting because it freezes in layers
which may be different colours and at times there appears to be little
specks in it. This is normal and as long as you have followed these
guidelines for storing the milk, don’t worry.

How long can breastmilk be stored and still used?


The guidelines below are for healthy babies at home. If you are collecting
and storing milk for a premature or sick baby in hospital ask for advice
from the staff in the nursery.
Breastmilk Freezer Refrigerator Room Temperature

2 weeks in
freezer
compartment Colostrum: 12–24 hours at
inside 26°C or lower
3–5 days (4°C or lower)
Freshly expressed 3 months in Mature milk: 6–10 hours at
breastmilk (in a sealed freezer section of N.B. Store in the back of the 26°C or lower. It is always
container) refrigerator on the top shelf
refrigerator with advisable to use a refrigerator
where it is colder—not in the
separate door when available.
door.
6–12 months in
deep freeze
(-18°C)

Previously frozen
breastmilk (thawed in
Do not refreeze 24 hours 1 hour
refrigerator or under
running water)

In general
Use fresh milk whenever possible.

Breastmilk has a good shelf life, but it is always advisable to refrigerate


it soon after expressing when a refrigerator is available.

Freeze milk that will not be used within two days.

Use the oldest milk first; date the container at the time of collection.

When adding cold, unfrozen milk to stored frozen milk, don’t leave
more than a week between additions.

Using the stored milk


If the milk has not been frozen, stand the bottle in a container of warm
water to warm it before feeding or give it as it comes. The person feeding
your baby should always test the temperature of the milk by shaking a
little from the teat onto the inside of their wrist.

If the milk is frozen, defrost it gently. Here are two ways:

Defrost just before feeding by running cold water over the container.
Gradually increase the water temperature until it is warm to hot. Keep
the container in the water until the milk defrosts. It’s similar to the way
you defrost frozen prawns.
Alternatively, you can prepare in advance by taking the frozen milk
from the freezer and leaving it in the fridge until it defrosts. It must be
used within twenty-four hours—if it hasn’t fully defrosted when it’s
needed use some warm water. This method has the advantage of having
milk available instantly for a feed but it may be wasted if your baby
doesn’t use it. Breastmilk should never be refrozen.

Microwaves shouldn’t be used to defrost or heat breastmilk as they are a


safety hazard.

Is there enough milk?


You may find yourself worrying if you have enough milk. Worrying about
milk supply is one of the main reasons women stop breastfeeding, yet a lot
of the time the worry is unfounded.

How can you tell if there is enough milk?


Mothers and those around them mistakenly think there is not enough milk
at times. All is likely to be well if:

Your baby has six to eight pale, wet nappies every day.

She has a good poo every so often or at every feed.

She grows steadily—which is easy to see as she grows out of her


clothes, her bassinet and fills up the space in her car safety restraint.
Weighing her from time to time also gives you an idea of how she is
growing.

Here are some common reasons for believing there may not be enough
milk. If all the signs mentioned above are present it is unlikely the
following things indicate a low supply.

Your baby keeps turning her head and opening her mouth as if she
wants to suck on something even after several good feeds: This is
called the rooting reflex and is present in all babies from birth, usually
disappearing by three to four months of age. Babies do this when they
are hungry, but they also respond like this when they are awake for any
length of time, restless, over-stimulated, bored or over-tired. Often
wanting to suck on something is a sign of needing sleep, not food.

No sensation of a let-down: Some women never feel a let-down,


others find the let-down sensation fades or disappears as their baby
grows older, so not feeling a let-down is not a sign of low supply unless
there are other indications.

Your baby is very unsettled a lot of the time: The reasons why some
babies cry a lot and have trouble falling asleep and staying asleep are
complex and varied. If your baby is taking the breast well and growing
and developing as she is meant to, it is unlikely her unsettled behaviour
has anything to do with your breastfeeding.

You can’t express much milk: Many women who breastfeed well
can’t express. Your ability to express isn’t a reflection of how much
milk your baby takes.

Your baby starts to suck her fists all the time: Between eight and
twelve weeks babies’ hands are never out of their mouths. ‘Hands in the
mouth’ is a normal part of their sensory/motor development and not a
sign of hunger.

Your breasts change; they stop leaking, become softer and smaller
and the full feeling goes: Breast changes like this are normal and
happen between six and twelve weeks. Breastfeeding becomes easy and
efficient, the fullness and leaking which happens in the early weeks is
only temporary.

Your baby stops pooing a lot and only goes once every few days:
Most breastfed babies don’t poo nearly as much after the first six weeks
—a big soft poo less often does not mean your supply is low.

Your baby takes a lot less time at the breast: Breastfeeding is a body
function and like all body functions, the more you do it the better you
get. It’s a bit like running around the park—after you’ve been doing it
for a few months it’s much less tiring, you enjoy it more and do it
faster. As your baby grows she becomes more skilled at removing the
milk and your body responds, so you become an efficient team.
Your baby wakes a lot at night or suddenly starts waking a lot at
night: Night-time waking is dealt with in detail in Sleeping and Waking
in the First Six Months, chapter 14 and The Crying Baby, chapter 15. In
general, unless there are obvious signs of ‘not enough milk’, night
waking in itself is not a sign that babies need more food.

How do you know there is a problem?


Sometimes, of course, the feeling that your baby is not getting enough
milk is correct. It is not clear-cut. Obsessions with weight gains in the past
meant many women weaned when they didn’t have to or want to, but if
you are unsure of what is happening, weighing and measuring your baby is
still the best guide. Weighing is best done with an experienced health
professional who is as interested in breastfeeding as you are and can use
the weight as a guide to work with you to resolve the problem—if one
exists. Weighing is not a test to determine whether or not formula should
be given.

Interpreting weight
It’s quite likely your baby is not getting enough milk if:

There is a constant, gradual weight loss;

She is still below her birthweight at four weeks or older;

She keeps gaining less than 500 grams a month.

Other signs which may indicate there’s not enough milk:

A sudden change from a reasonably content baby to increased fussiness


and more unsettled times;

A sudden increase in the number of feeds which don’t seem to satisfy


your baby as much as they used to;

Fewer wet nappies. You may also notice some nappies are damp rather
than wet (it’s difficult to judge nappy wetness with the latest high-tech
disposables as they absorb fluid very efficiently);
Infrequent poo is fine as long as there’s a good big soft one when it
comes. Infrequent green ‘splats’ are often a sign of underfeeding.

When your baby is healthy and well, temporary underfeeding is rarely an


emergency situation but there are times when prompt medical attention is
needed. It is unusual for these things to happen simply because of a low
milk supply but here are some signs something more serious is wrong:

Your baby is floppy and pale and won’t suck;

Your baby is not waking for feeds;

Most of her nappies are dry or just damp, rather than wet;

She has a sudden, major weight loss over a short period.

Why isn’t there enough milk?


Here are the most likely reasons:

Difficult start: If your baby is premature, sick or jaundiced, your birth


complicated, or your baby sleepy, you may find breastfeeding takes
longer for everything to start working so there may not be enough milk
for a while.

Your position, your baby’s position: If your baby is not in the best
position for breastfeeding, she can’t suck well enough to make
everything work as well as it can. If you are uncomfortable or ill at
ease, your body can’t respond and this affects the amount of milk you
make.

Not enough feeds: If your baby doesn’t take the breast often enough
your body doesn’t get a strong message to keep making milk, so the
amount of milk available gets less than your baby needs.

Strategies for sore nipples: Temporarily stopping breastfeeding or


using a nipple shield can decrease the supply.

Hormonal changes: Sometimes hormonal changes in your body alter


the balance slightly so less milk is made, for example, pregnancy or
menstruation. Concerns are also often raised about the mini pill
interfering with the milk supply. In theory the mini pill (which is
progesterone only) should not diminish milk supply, unlike oestrogen
which does. Two researchers in Australia have been unable to
demonstrate in controlled studies that the mini pill diminishes the milk
supply; but to be absolutely sure, a study would have to be done with
larger numbers of women over longer periods of time. Overseas
researchers claim that the mini pill demonstrates no consistent alteration
of breastmilk composition, volume or duration of lactation.
Occasionally there are times in my work when I suspect that the mini
pill may contribute to fussy feeding and a diminished milk supply, but
it is usually very hard to be certain whether the problem is caused by
the mini pill or other reasons. However, there are times when stopping
the mini pill seems to help increase the milk supply.

Smoking: Smoking affects the milk supply for some women and not
for others. When it does, the supply tends to start out all right but gets
less as the baby grows. Lots of low milk supply difficulties can be
solved, but if you smoke and your supply gets low the chance of
increasing your milk to meet all your baby’s food needs for any length
of time is unlikely. Reducing the number of cigarettes you smoke to as
few as possible, not smoking in the hour before feeding and not
smoking while you feed reduces harmful effects. The relationship
between smoking and low milk supply is unclear, but it is well
documented. However, it must be emphasised that if you are a smoker
who can’t stop, all the advantages of breastfeeding are still there for
your baby, so breastfeed for as long as you can (which may turn out to
be a long time).

Illness: If you or your baby become sick you might find there is not
enough milk. Again, this should only be a temporary situation until you
recover. If your baby is sick and not sucking as often or as well, you
need to express for comfort and to remind your body to keep making
milk.

Lifestyle, stress and/or exhaustion: Lots of women find their


breastfeeding works well even when they lead busy lives, get very tired,
work outside the home, have stressful days or come through a major
upheaval. For others, breastfeeding is a fine balance and doesn’t work
well unless they adapt their lifestyle to breastfeeding. Lifestyle
adjustments are often only temporary, but some women find that for the
period that their baby is exclusively breastfed they have to limit their
activities, avoid major upheavals and make sure they are always well
nurtured and rested.

Breast reduction and other breast surgery may hinder milk


production.

The way the baby sucks: Breastfeeding takes two and occasionally the
baby’s technique just doesn’t do what’s needed to keep the milk
flowing. The baby is usually healthy and well and sucks on a teat quite
happily but when it comes to the breast, feeds in a way that does not
stimulate the mother’s supply. This is sometimes temporary and by
expressing to increase supply, use of a Supply Line (see chapter 8) and
a little formula the problem can be overcome until the baby sucks more
effectively. Occasionally it is impossible to resolve and either expressed
breastmilk or formula has to be given in a bottle.

Unknown: It is very distressing when you and your baby are doing
everything right and yet your baby does not thrive. This does not
happen very often, but there are times when there does not seem to be a
definable cause or solution for a low milk supply. Some researchers
believe that a small number of women do not have the metabolic
capacity to produce enough milk for their babies, however, to date there
is little work being done to investigate the reasons for this.

Apart from the possibility of underlying metabolic problems the following


things may play a part sometimes for some women:

Unresolved grief for the loss of another baby (cot death, stillbirth or a
baby given up for adoption).

A sudden emotional shock (such as the sudden death of a parent).

Intense homesickness (having a baby miles away from familiar faces


and places).

It must be emphasised that these things do not mean breastfeeding won’t


work. Successful breastfeeding can be a beneficial healing process in times
of emotional trauma, but occasionally the emotional trauma gets in the
way of the breastfeeding.

What do you do when there isn’t enough milk?


Fortunately, there are things you can do to increase the amount of
breastmilk your baby is getting without using extra food or weaning. Low
supply is usually a temporary difficulty.

Occasionally it is a longstanding problem and the breastmilk has to be


supplemented with formula or food from a spoon. This can often be done
carefully so breastfeeding continues.

Here’s a general guide for a temporary low supply. Ask your partner and
other family members around you to read this as well.

Support and encouragement from those around you makes an enormous


difference. Comments which constantly undermine your confidence
don’t help. For example, ‘The women in our family have never been
able to breastfeed’; ‘Are you sure she’s getting enough?’; ‘Your milk is
too watery’; ‘Put her on the bottle—it doesn’t matter’.

If possible, get help from an adviser who knows how to check your
position and your baby’s position during a feed.

Feed your baby whenever she’s hungry or awake and alert. Try not to
keep using a dummy to extend the time in between feeds. Remember,
she needs seven to eight breastfeeds every twenty-four hours.

On the other hand, don’t let your feeds go on forever in an attempt to


give your baby ‘the hindmilk’. Endless long feeds are exhausting and
aren’t an effective way to increase your supply. Frequent feeding has to
be balanced with rest and relaxation for you. As long as the position is
right, ten to twenty minutes of effective sucking does the job.

Always offer both breasts every feed. Try to make sure your baby is
offered the second breast when she is in an alert state. Change her
nappy and tickle the soles of her feet to wake her up if she is asleep. If
she still doesn’t take the second breast, don’t worry, offer both breasts
again at the next feed.

Plan a few days of complete rest. See if you can arrange help with the
household chores as resting while everything around you is in a state of
chaos is not very relaxing for most women. Take your baby to bed.
Feed her as much as you can while you watch the soapies, listen to
music and read the latest Mills & Boon. Avoid spending your rest time
endlessly roving around the internet—guaranteed to drive you dippy.

There is no special food which makes more milk, but if you stop eating
properly your body doesn’t work as efficiently, so make sure you stay
well nourished.

Avoid strenuous exercise programs and dieting rigorously to lose


weight.

If you are using a nipple shield, try as many feeds as possible without
it; if you are giving bottles to rest sore nipples try to let your baby take
your breast again as soon as possible.

Express to make more milk, but with caution. When there are
difficulties with the position and your baby’s sucking technique needs a
little time to develop, expressing a few times a day after feeds can be
useful. A full-service electric double pump is easier and more efficient.
When the positioning is better and your baby’s sucking is stronger you
can stop.

If your baby’s position at the breast is good and she sucks well then let
nature take its course. Frequent feeds and rest should solve the problem
without expressing as well. Expressing to increase the milk supply is
not always useful as it has a tendency to make a stressful situation even
more stressful, which doesn’t do a lot to help the milk flow. If
expressing as well as feeding makes you tense and hassled then it is
unlikely to be of much benefit.

When low supply becomes a longstanding problem:

If you have access to one, a residential mother and baby centre where
you can rest and get help may suit you. Or, going home to your mother
might be a solution.

If after a period of time you have to give some extra food because your
baby is not gaining enough weight, start with a small amount of
formula (30–60ml) once or twice a day after a good breastfeed.
Continue to feed frequently, rest and make sure you are both
comfortable at feed time. A small amount of formula does not mean all
is lost!

An option instead of a bottle and teat is a Supply Line. A Supply Line


consists of a container similar to a bottle which contains either
expressed breastmilk or formula which is worn in a pouch around the
mother’s neck. A piece of fine tubing which carries the milk from the
container to the nipple is gently taped to her breast so the end of it lies
near the nipple. When the baby sucks at the breast the milk is drawn
through the tubing into her mouth at the same time as milk from the
breast. For some mothers use of a Supply Line helps while they build
up their supply and keeps their baby at the breast. Supply Lines don’t
suit everyone. Some mothers find them difficult to use, especially in
front of anyone, and some babies won’t suck with a Supply Line in
place while others quickly get used to it and won’t suck without it. Two
brands of Supply Lines are currently available—the Australian
Breastfeeding Association Supply Line available from the Association
and the Medela Supplemental Nursing System available from some
Family Care Centres. It’s essential to have a person experienced in
using a Supply Line to help you when you start.

Medications and herbal treatments (galactagogues) are frequently


prescribed to increase breastmilk supply and may be beneficial for
some women in some circumstances.

Prescription medications that are used for this purpose are drugs that are
used for other reasons, for example, nausea and vomiting, depression,
tranquillisers and blood pressure reducers, all of which may produce
milk as a side effect. Obviously only some of these drugs are
considered safe to use to increase the milk supply in otherwise healthy
women.

The use of herbs to increase milk supply has been around for centuries
and anecdotal reports of success are widespread; however, there is no
research in the medical literature to support or refute these claims. I
never see enough overwhelmingly positive results in my work to urge
women to try herbal remedies.

Galactagogues should not be used until all the common reasons for low
supply have been explored and the basics, as outlined on the previous
pages, have been tried. Galactagogues should always be used in
conjunction with frequent feeds, rest, emphasis on correct attachment,
and attention given to issues such as smoking, the health of the mother
and the way the baby sucks. They are not a miracle cure for low milk
supply, do not work for all women and can have unpleasant side effects.

Here are the commonly used galactagogues:

Metoclopramide (Maxolon, Pramin, Reglan, Maxeran): These are


used for nausea and vomiting and are the most common drugs
prescribed to increase milk supply. Side effects include ‘spacing out’,
drowsiness, fatigue, stomach pains and diarrhoea. They need to be
taken three times a day for no longer than two weeks.

Domperidone (Motilium): A similar drug to above, normally used for


nausea and vomiting and gastro-oesophageal reflux but causes fewer
side effects.

Herbal remedies: Traditionally herbs such as fenugreek, garlic,


caffeine, fennel seed, blessed thistle and alfalfa have been used but it is
important to make sure they come from a reputable source and must be
used according to directions. I don’t recommend any of them; however,
if you are keen to give a herb a go, best to talk to a lactation consultant.

From four months onwards babies can be supplemented with food from
a spoon instead of formula in a bottle—an option which can work well
when it seems unlikely the milk supply is going to provide all your
baby needs. When your baby is not getting quite enough breastmilk and
you have done all the best things to do to increase your milk, she can
get extra food from rice cereal, fruit and vegies. Trying food from a
spoon instead of formula in a bottle means your baby still gets all the
milk you do make because:

It takes time to increase the amount she manages to eat from a


spoon, which means she is still keen to take the breast. Large
amounts of formula in bottles go down quickly, the baby loses
interest in the breast and bottle feeding takes over.

Food from a spoon is not an alternative food source taken by


sucking, so she eats from a spoon and sucks from the breast.

The extra calories from the food helps your baby gain weight, you
gain confidence and often the milk supply improves.

Remember this is an option. It doesn’t suit all mothers and babies


when low supply is a problem and your baby should be at least four
months old before you try it.

‘Not enough milk’—summary


Not having enough milk does not happen nearly as often as everyone
thinks it does. Check carefully why you think there is not enough. If you
can, talk it over with an experienced breastfeeding adviser.

If it does seem to be a problem:


Check your position when you are feeding;

Check your baby’s position—she may need tucking in closer to you;

Feed your baby seven or eight times every twenty-four hours;

Always offer both breasts;

Try to get some extra rest;

Can you stop smoking or cut down?

Delay taking the mini pill for contraception;

Expressing after some feeds may help.

If it becomes longstanding:
Offer some formula (a small amount to begin with) or any expressed
breastmilk you might have after two or three breastfeeds every twenty-
four hours; OR
A Supply Line might suit you and your baby; OR

Give one bottle of formula or previously expressed breastmilk once a


day in the evening. Give the appropriate amount for age. Let your
partner give the bottle while you have a complete break. Continue
giving seven or eight breastfeeds the rest of the time, taking care with
positioning. Stop the supplements if your supply increases; OR

Consider medication, with caution; OR

Start food from a spoon when your baby is four months old (see
chapter 18). Continue breastfeeding. Slowly build up the food to two to
three meals a day. Give the food after the breast and continue seven to
eight breastfeeds every twenty-four hours.

Lots of milk
Some women find they have so much milk it causes temporary difficulties.
If you have lots of milk you might find your breasts always feel full and
leak all the time. Your baby will probably have big weight gains, poo
heartily and everywhere and may gasp and pull off the breast because the
flow is fast at times. She is also likely to have some good vomits. Some of
these things are distressing, but they are harmless. As your baby grows and
the milk flow settles you will find the leaking, pooing and vomiting gets
less.

What can you do?


At first, do nothing as the milk flow often adjusts to the baby’s needs
quite quickly.

If the milk flow continues to be abundant, try feeding your baby only
one breast each feed for a while. Put your baby back on the first breast
instead of offering the second breast. For comfort only, hand express
the breast your baby doesn’t take—just express until the full feeling
stops.

Hand expressing a little milk just before a feed sometimes makes it


easier for your baby to manage when she goes to the breast.

Sometimes changing positions helps. The underarm hold (see chapter 6)


sometimes seems to stop the choking.

You might find the leaking is embarrassing. Try using the non-
disposable breast pads made from a soft fabric that allow moisture to
pass through and keep your skin dry. Multi-coloured tops are a good
disguise.

Remember, this is temporary and will not go on for the whole time you
breastfeed. In the meantime take pleasure in watching your baby thrive
on all your wonderful milk!

For a small number of women, oversupply is a distressing situation which


causes constant breast problems such as blocked ducts and mastitis (see
chapter 8). The baby may also be very unsettled and become a fussy
feeder, pulling away from the breast after only sucking for a short time.
Like many breastfeeding difficulties these things will usually resolve in
time. (It’s unusual for oversupply problems to continue past three months.)
Here are some suggestions to manage:

Try to feed your baby when she is sleepy on a softer breast and leave
her on the same breast until it is fully drained (very soft). Hand express
the other breast for comfort if you need to.

Avoid skipping feeds until the supply has settled. If your baby starts
sleeping longer than five hours at night you may need to express at the
time of the missed feed if you wake with painful, bursting breasts. (It’s
very unfair when the baby lets you sleep and your breasts don’t.)

Continue to make sure you follow the guidelines for positioning so your
baby can drain your breast efficiently.

Check your breasts frequently for hard, painful or red segments. Use
massage and hand or pump expression to relieve the troublesome spot.

Fast flow
Milk often spurts out when you let-down at the beginning of a feed or
halfway through. Babies find this upsetting when they are young and often
choke and cry and pull off the breast. Fast flow is not necessarily
associated with an oversupply of milk so care has to be taken that any
strategies used for a fast flow do not diminish the milk supply. If your
baby is generally settled and you are not having the difficulties described
in the previous section (see Lots of milk, chapter 8), just try hand
expressing a small amount of milk before the feed. You may also find
changing the position from across your front to under your arm halfway
through the feed helps avoid choking on the second let-down. As your
baby grows and the let-down intensity decreases the problem rights itself.

Clicking noise when breastfeeding


(the baby, not you)
Sometimes babies click while feeding. If your baby is thriving, the feeding
is comfortable and your nipples are not sore (apart from some discomfort
for twenty to thirty seconds at the beginning of the feed) ignore the
clicking noise. If your nipples are hurting throughout the feed or if your
baby is very unsettled and perhaps not gaining weight, the clicking in this
instance is a sign that the position is not right. If you have an adviser, ask
for help to check your feeding. If not, go back to the basic guidelines for
positioning and go through them step by step. Changing position from
front to underarm (twin style) might help.

One breast bigger than the other


Some women find when they are breastfeeding one breast is bigger than
the other. It may be because the baby prefers one breast and sucks longer
and more efficiently on that breast or because one breast just makes more
milk. If this happens it is much more noticeable in the first six to eight
weeks and then tends to settle. At times the breast size will continue to be
different for the whole time the baby is breastfeeding, but the breasts do go
back to being similar after weaning—so if this is happening to you, don’t
panic about being lopsided forever.
Blocked ducts
When you are breastfeeding, the milk is carried from the glands deep
inside the breast to the front of the breast by a network of tiny tubes called
ducts. If one of the tubes becomes blocked the milk can’t flow as well and
you are likely to notice a lump which at first may not be painful. The lump
is thickened milk. One or more can form at any time but this is more
common in the first three months.

Why does it happen?


Something holds up the milk flow. Here are the usual causes for a blocked
duct, but sometimes it is difficult to pinpoint a reason.

If your baby’s position at the breast is not quite right, the breast won’t
be well drained after a feed so there’s more chance of milk banking up
in one of the ducts. Pain or discomfort throughout the feed is a sign the
position is not right. This should not be confused with the toe-tingling
discomfort many women experience for the first thirty seconds before
and after a feed in the early weeks. (Opinions vary as to the cause of
toe-tingling discomfort, but it is not due to positioning when the feed is
comfortable apart from the uncomfortable sensation at the beginning
and end of the feed.)

Sometimes the way breasts are handled harms the ducts. Try not to grip
them tightly when you feed your baby. Using a finger to hold the breast
away from your baby’s nose while she feeds is unnecessary when the
position is correct. When you massage and express, try not to squeeze
or slide your hands on your breasts.

Tight bras or clothing putting pressure on breasts can stop the milk
flow.

If the normal pattern of your breastfeeding is interrupted, ducts may


become blocked. Things like delayed or hurried feed, going back to
paid work, stopping night feeds, travelling or giving up breastfeeding
suddenly can contribute to problems with the milk flow.

What can you do if you feel a lump anywhere in your breasts?


Feed frequently and offer the lumpy breast first for two feeds in a row.
Try changing the way you feed. If you normally sit, lie down on your
side. If you usually feed with your baby’s body under your arm, try
holding her in front of you. If you can do it so you are both
comfortable, feed her so her chin points towards the lump.

Massage the lump firmly with the same technique used for self breast
examination. It’s important not to squeeze your breast or slide your
hands down the breast. The lump may be painful and red. Sometimes it
helps if the lump is massaged by your partner, lover or friend with some
nice oil.

Massaging and hand expressing while sitting in a warm bath helps if the
breast is still lumpy and uncomfortable after a feed.

Arm exercises similar to breaststroke movements also help.

Make a point of putting your feet up and resting whenever you can,
especially when your baby is sleeping during the day.

Mastitis
Mastitis is a medical term for a red, swollen breast. If mastitis happens
while you are breastfeeding, it is very painful and usually caused by
bacterial infection. The Royal Hospital for Women in Sydney estimates
that 10 to 20 per cent of women develop a breast infection in the first few
weeks of breastfeeding.

Why does it happen?


An abundant supply in the early weeks while the milk supply adjusts to
your baby’s needs.

A blocked duct which doesn’t resolve.

From damaged nipples when bacteria enter the duct through a graze or
a crack in the nipple.
Mastitis is more likely to happen if you become ill or exhausted;
smoking may also contribute.

Sometimes the cause is unknown. Mastitis can strike like lightning and is
often mistaken for influenza as sometimes at first there is only minimal
breast tenderness and no sign of a blocked duct. When this happens the
breast symptoms do appear later.

What are the symptoms?


You feel hot, feverish and depressed.

Your breast may be red, swollen and exquisitely tender.

There are often red streaks on the sore breast.

With prompt treatment you may be able to avoid antibiotics through the
use of warm packs, massage, rest, anti-inflammatory medication, arm
exercises and frequent breastfeeds.

Whatever you do, don’t stop breastfeeding. Let your baby suck—your
milk will not harm her in any way.

If this works you will know, because the influenza symptoms will go away
and the pain will be gone from your breast.

On the other hand, if after six to eight hours there is no improvement and
you feel very ill and depressed, you need medication.

Antibiotics are the most effective medication for treating infective mastitis
and preventing the risk of an abscess, so visit your family doctor. The
antibiotics will not harm your baby.

Continue frequent breastfeeding while you take them. Disregard advice to


stop breastfeeding temporarily—this is wrong advice and can lead to
added discomfort and unplanned weaning.

It is important to take a ten-day course of antibiotics. Take the whole


course even though you will feel like a new woman in forty-eight hours.
A few women seem to get one bout of mastitis after another. Recurrent
mastitis is very wearing and the precise reason for the problem varies
between women and for the same women between bouts. Finding the exact
cause and fixing the problem so the mastitis doesn’t keep recurring is
difficult and different things may work (or not work) for different women.
The Australian Breastfeeding Association can be of great help in this
situation as word-of-mouth remedies from women to women can
sometimes offer potential solutions unavailable from other sources.

Breast abscesses
An abscess is a collection of pus (like a boil) which happens in a breast
either because mastitis has not been quickly and effectively treated or
because of an infection from cracked or grazed nipples. If it’s because of
damaged nipples the abscess is likely to be near the nipple; if it is because
of mastitis it forms where the red infected area of the breast is. An abscess
is keenly painful.

Breast abscesses are rare, but if one forms, medical attention is needed
immediately. Treatment involves antibiotics and usually surgical drainage.
Breastfeeding should continue even if you are losing pus from your nipple
—it will not hurt your baby. If for any reason you can’t feed from the
infected breast or it is too painful, express it until you can put your baby
back to the breast.

If you have to go to hospital, see if you can arrange to take your baby with
you or get help to express your milk regularly. Continuing to breastfeed
from both breasts during and after treatment is recommended, but milk
often continues to leak from the incision following drainage of an abscess,
which can be hard to deal with. Nevertheless, although it is messy and
aesthetically a problem, there is no harm in it. If you continue
breastfeeding you may find that the breast with the abscess doesn’t
produce as much milk as it did before the abscess appeared. Interestingly,
research shows that the bulk of the milk supply is found in different parts
of the breast with each baby, so with another baby it is likely that the
breast will function as if there has never been a problem.
Persistent sore/damaged nipples
Most damaged nipples heal well in the first six weeks, but unfortunately
some women find feeding is not particularly enjoyable (an understatement
some would say) for up to three months because of ongoing sore nipples
and breast pain for which there may not be a solution other than time. If
you reach a point where you cannot bear the thought of another breastfeed,
it is advisable to take your baby from the breast and express for a week
before putting her back. Hand expressing is often advised in this situation,
but is unrealistic for many women who find it easier to use an electric
pump or hand pump. Give your baby the expressed milk in a bottle. When
your nipples (or nipple; it is often only one nipple that is a problem) are
healed, start to put your baby back to the breast once or twice every
twenty-four hours, slowly building up to full breastfeeding again. If
possible, get help from a child and family health nurse or lactation
consultant the first time you put her back to the breast.

Sometimes ongoing nipple soreness can be diagnosed as specific medical


conditions, which means they can be helped by treatment. The range of
conditions follow.

Candida (commonly known as ‘thrush’) of the nipples


Candida causes a common fungal infection known as thrush. It is able to
infect the deep organs of the body as well as the skin, and particularly
affects mothers and babies. The most common species that causes the
infection is known as Candida albicans; however, there are other species
of Candida, which while much rarer also cause human fungal infections.
The significance of this is that the rarer species are resistant to commonly
used medications for Candida albicans, which may explain some of the
times when thrush doesn’t appear to respond to treatment.

Nipples may become infected with Candida in a number of different ways:

Candida infections occurring in women are common in the mucous


membrane which lines the vagina. If this is present when a woman
gives birth her baby will be born with the same infection in the baby’s
mouth and digestive tract.
Candida can occur in a baby’s mouth whether her mother has a vaginal
infection or not.

Women who are breastfeeding sometimes find the combination of their


baby’s sucking, the constant dampness and friction of breast pads and
bras leads to thrush on the areola and nipple.

A fungal infection of the areolas and nipples may happen at the same time
as cracked and/or painful nipples in the early weeks after birth, following a
course of antibiotics for mastitis, or out of the blue at any time when there
is no history of sore or damaged nipples or mastitis. A definite diagnosis is
sometimes difficult and I feel there is a tendency for thrush to be over-
diagnosed as a cause of sore nipples and breast pain, however, when the
signs and symptoms are clear, thrush can be treated effectively with
miconazole (which comes in an oral gel). The treatment should be
continued for a week or more to be effective. The baby should also be
treated, even if there is no sign of thrush in her mouth, to avoid the
infection passing back and forth between mother and baby. At the current
time, oral antifungals are also often given to the mother for at least two
weeks.

The following things strongly suggest a fungal infection of the areola and
nipples:

Dry, red (‘sunburnt’) nipples that suddenly start to hurt where


previously they didn’t.

Pain before, during and after a feed, even when the baby is well
attached to the breast.

A burning pain radiating up the breast from the nipples, especially after
a feed.

See also Needle-sharp pain, chapter 6.

Dermatitis
Dermatitis is caused by something irritating the nipple and areola such as
creams, sprays, clothing or soap which makes the nipple and areola red
and sore. Women who have sensitive skin and suffer from eczema are
more likely to develop nipple dermatitis.

Expose your nipples as much as possible, taking care outdoors if it’s


windy and/or sunny. Wear cotton near your skin. Be very careful about
what you put on your nipples as lots of products are likely to make things
worse, not better. A hydrocortisone ointment (ointment is better than
cream on a moist surface) will relieve the inflammation if the diagnosis is
definite.

Hydrocortisone will not help if the problem is caused by the way your
baby is taking the breast.

Small, white blisters


Occasionally milk collects in a spot on the nipple, just under the skin, and
looks like a whitehead. The skin around the spot is swollen and painful. As
the collection of milk causes a blockage in the milk flow there may be
associated lumps further back in the breast.

The discomfort doesn’t last for long. Usually the baby’s sucking removes
the collection of milk but if it is very painful, try having a warm bath or
shower then gently apply some pressure behind the spot and see if it will
pop out. Sometimes removal with a sterile needle by a family doctor or
midwife who is skilled in the area is advisable.

White nipple (nipple vasospasm)


Primary vasospasm (vasospasm that happens without any evidence of
nipple damage or infection) is similar to chilblains of the nipple. It is not
common, but does happen to a small number of women who may also
have a history of experiencing numbness, tingling and pain in their fingers
and toes, but not always. The pain, mostly in the nipple, sometimes in the
breast as well and usually only on one side, can start soon after birth or as
late as eight weeks afterwards, and is nearly always associated with a
breastfeed. The nipple goes white, tight and hard and becomes extremely
sensitive. A severe jabbing pain is experienced at the time the nipple goes
white and again when the blood returns, changing the nipple colour from
white to blue and back to red. The pain and blanching of the nipple may
continue in intervals over one or two hours. The nipple blanching and pain
often disappear in six to eight weeks but occasionally some women
experience pain and blanching for the whole time they breastfeed.

Secondary vasospasm is vasospasm that occurs as a reaction to nipple pain


caused by an infection—thrush or bacterial—or painful feeding from
nipple damage caused by attachment problems.

Treatment
It is important to diagnose and treat any damage or infection of the
nipple, and ensure that your baby is taking the breast in the best way to
avoid damaging the nipple (see chapter 6 for suggestions on how to
manage sore nipples). In this instance, cover your nipples instead of
airing them, as exposure to cool air intensifies the pain of vasospasm. If
possible contact an ABA counsellor, a lactation consultant or your child
and family health nurse.

Avoid chilly environments and getting cold while you breastfeed. Wear
warm clothes and apply a warm compress to the breast before and/or
after the feeds.

Smoking and caffeine exacerbate this condition by further constricting


the blood vessels.

Magnesium and calcium supplements may be helpful for some women


—evidence supporting this is contradictory.

A medication, nifedipine, has been found to be safe and often beneficial


(not always, but is definitely worth a try). However, you will need to
find a family doctor who is familiar with the condition and the
medication. Lactation consultants cannot prescribe nifedipine, but if
you’re having trouble finding a doctor, a lactation consultant can either
pass on the information about the medication as well as the correct
dosage or refer you to a suitable doctor.

Breast pain
Persistent breast pain that is not related to an obvious condition such as
mastitis or referred pain from damaged nipples is a problem for a small
number of women. It is perhaps more common in women who experience
troublesome breast pain prior to pregnancy or who have very sensitive
skin. If you feel the pain is unusual, please see your family doctor. Here
are some suggestions that have been found to be helpful:

Reduce the caffeine in your diet. Apart from coffee, caffeine is found in
many other drinks and processed foods.

Reduce the salt in your diet. Again, check processed foods.

Take vitamin B1 and vitamin B6 tablets—50mg a day.

Wear a firm, well-fitting cotton bra day and night.

Aching upper back and shoulders


This can be a problem for some women while they are learning to
breastfeed, especially if there is an old injury or a past history of problems
in that area. Take care to sit square on with a straight back. Try not to lean
over your baby—bring her to your breast not your breast to her. Use a firm
pillow to support your baby.

Warmth around your upper back and shoulders helps (a shawl or soft
blanket). Heat to your back and shoulders (a hot water bottle) after feeding
is soothing. Physiotherapy and/or massage can be beneficial. Back and
shoulder discomfort gradually improves as you and your baby become
more skilled in this breastfeeding business.

Should I wean?
You may find yourself in a dilemma where you feel breastfeeding is the
pits but the thought of weaning also fills you with dismay. I find that most
women get through this time as long as their babies are thriving and they
have good support from family and a health professional. The problem will
not last forever and you will almost certainly be delighted that you carried
on.

It is very difficult, however, to keep going when there is the added


problem of a low supply which cannot seem to be resolved especially if
your baby is not thriving. In this situation you may need to talk to your
health professional about combining breast and bottle feeding or slowly
starting to wean.

Combining breast and bottle feeding


Combining breast and bottle feeding is an option when, despite all efforts,
there is not enough breastmilk. Many babies in this situation will happily
take both. Even though the amount of formula may indicate that most of
the feed is via the bottle, there are still benefits from giving your baby the
breast before each bottle and perhaps at other times, such as in between
feeds, for comfort or to get her off to sleep. Give your baby ten minutes or
so at both breasts then offer the bottle with the amount of formula required
for your baby’s age (see chart, chapter 7). Combining breastfeeding and
formula feeding in this way can continue for as long as you are both
happy.

Breast refusal
Breast refusal is a broad term used to describe a range of behaviour at the
breast where the baby, for reasons that may not be clear, fusses and
fidgets, screams or gets distracted and refuses to feed. There is often no
satisfactory diagnosis of the problem or a solution although you’ll find
suggestions below. Often the most comforting thing to know is that this
behaviour is quite common for many normal, healthy babies. The most
common age when it becomes a problem is between eight and sixteen
weeks, but there are variations on this—sometimes it starts soon after
birth. It often happens out of the blue although some babies who refuse the
breast have always been fussy feeders.

What happens?
When you try to feed your baby she might suddenly cry, suck, pull off the
breast then keep crying or simply fidget and squirm and refuse to take the
breast. You might find she refuses every feed for twenty-four to forty-eight
hours then takes the breast again as if nothing has happened, or she might
take some feeds well and refuse others. The on-again-off-again feeding
may go on for three weeks. Often the night and early morning feeds are
fine with each feed during the day becoming more and more difficult. By
evening everyone is very tense.

If this happens to you, you are bound to feel devastated, wonder what on
earth you’re doing wrong and even lose confidence in yourself and your
breastfeeding. Don’t panic. Be aware that it is not your fault; it happens to
lots of mothers; it is nearly always temporary; with the right advice and
moral support you can get through this dilemma and continue
breastfeeding.

Why does it happen?


The following reasons are possibilities. You may find one that applies to
your situation and provides a solution; however, much of the time a
definitive cause and treatment remains elusive.

Baby causes:
Illnesses such as coughs, sore throats, ear infections or blocked noses.
Rare occasions crop up when refusing the breast is a sign of something
more serious so if your baby is floppy, pale and not wetting her
nappies, please see your doctor straight away.

Frequent regurgitation and/or heartburn—to be honest this is a handy


diagnosis and rarely likely to be the reason for the breast refusal.

Distractions, especially around three to five months, can cause a few


breastfeeding hassles including breast refusal. At this age babies
become fascinated with the world around them. Feeding is not as
important as what is going on elsewhere. Even though it seems like they
are having days and days where it seems they don’t feed much they
continue to look the picture of health.

Shorter sucking time. Don’t confuse breast refusal with a shorter


sucking time. Breastfeeding is a body function and the process becomes
more efficient as time goes by. Your baby learns to feed very
competently and your body responds so the feeds become much shorter.
Avoid trying to keep her at the breast longer than she wants.

Mother causes:
A change in perfume, talcum powder or a radical change in diet.

Early mastitis which leads to salty-tasting milk.

Any illness or stress which may deplete the breastmilk supply or inhibit
the let-down.

Medication which may alter the taste of the breastmilk.

Hormonal changes which may alter the taste or amount of the


breastmilk, for example, the progesterone-only pill, early pregnancy or
menstruation. Usually any problems caused by hormonal changes are
temporary—the fussy feeding stops when the baby and breasts adjust.
Some women find that breast refusal occurs when a period is due and
stops when it is over.

Breastfeeding causes (for reasons which may be unknown):


Low milk supply (see chapter 8.)

A slow let-down response—there are no useful explanations for this


apart from illness or stress, as noted on the previous page. Relief of
stress and extra rest can help.

A rapid let-down response that frightens the baby, who then gets a
temporary mental block about the breast.

What can you do about breast refusal?


Most episodes of breast refusal are not related to ill-health (mother or
baby) but if you are concerned see your family doctor to make absolutely
sure and to set your mind at ease.
Check that there is enough milk if you suspect there may not be. Breast
refusal is usually not related to low milk supply but in this instance
weighing and measuring your baby with a competent health professional is
the best way to be absolutely sure and put your mind at rest. Extra rests for
you and company from a calm person during the day and evening helps.

A basic plan of action you can follow


Try not to see what’s happening as a personal rejection (easier said than
done, I know). As mentioned before, breast refusal is not uncommon,
usually temporary and not because you are doing anything wrong.

When your baby cries, pulls off and refuses the breast, stop the feed.
Trying to make her take the breast usually makes things worse.

Change tactics—go for a walk, hand her over to a calm person or see if
she will sleep.

When possible pick your baby up and feed her when she is still drowsy
after a sleep, before she fully wakes.

Sometimes the following strategies work: Let your baby suck on a


finger then try slipping the nipple in; calm her by singing and rocking
before the feed; try alternative feeding positions (see chapter 6); hand
express some milk into your baby’s mouth; try breastfeeding in the
bath.

Usually the night feeds are good so try to enjoy them and bear in mind
that your baby is probably making up for the fussy day feeding by
feeding well at night.

Avoid bottles and formula as much as possible. Mostly when breast


refusal happens extra fluids in bottles are not needed. If your baby
refuses the breast for twenty-four hours or if she is sick, you might need
to use a bottle or a small cup. Giving a bottle has the potential to cause
more stress—either because the baby won’t take it or because she
decides she prefers it to the breast. Sometimes, though, a bottle can
provide a welcome opportunity to ease the tension.

Express for comfort and to keep the milk flowing if you need to.
Breast refusal is usually only temporary, lasting from two to three days to
two to three weeks, but occasionally a baby cannot be persuaded to return
to the breast. The problem becomes permanent instead of temporary. This
doesn’t happen very often but when it does some of the pleasure of
breastfeeding goes and weaning becomes an attractive alternative. It is
important for you to have a nice time with your baby so this is certainly
reasonable in these circumstances.

Juice, water and vitamin drops


Your baby doesn’t need daily water (even in hot weather), juice, vitamin
supplements or fluoride. Premature babies do need extra supplements for
the first three to four months after birth as they do not arrive with stores of
iron and vitamins.

Breastmilk contains all of the above apart from fluoride, which is not
needed until the third year and only then if you live somewhere where
there is none in the water supply.

Some mothers do give their baby water in a bottle for a few reasons that
have nothing to do with nutrition. Here they are—you may decide yourself
if you think it’s a helpful thing to do. When your baby is very unsettled
and you’ve just done the twentieth feed of the day, letting someone else
give her some water in a bottle may give you a rest and break the unsettled
cycle—if she’ll drink it. Babies often won’t drink water.

Regular drinks from a bottle might (no guarantee) prevent potential


difficulties caused by bottle refusal at a later date when it would be very
useful for her to drink from a bottle.

If you become ill


It’s certainly no picnic when you are unwell and you have a baby or young
children to look after. Mothers can rarely take sick leave.

When you are breastfeeding the milk supply might be less than it is when
you are well. Babies manage quite well when there is less milk for a while
without anything alarming happening. Is your partner able to take time
from work and/or go to your baby at night, change and settle her so all you
have to do is feed? When your partner is around or anyone else who can
help, take your baby and go to bed. Your baby is unlikely to catch coughs,
colds, the flu, or a tummy bug through your breastmilk. Being breastfed
protects her from these things to a large extent, especially gastroenteritis,
but don’t forget to wash your hands carefully before feeds and stick to all
the rules of good hygiene.

Occasionally a medical condition arises and hospital admission is required.


Make sure you tell your doctor you are breastfeeding as sometimes it’s
possible to take your baby with you. You may have to express or get help
to express for a short time if you are not well enough to feed so someone
else can feed your baby. If there is short-term use of problematic drugs the
milk can be discarded until the drugs are out of your system and
previously stored breastmilk or formula used for a while—there is no need
to wean.

Staff in general hospitals are usually not familiar with breastfeeding,


expressing or the distress of weaning suddenly, especially when the
mother doesn’t want to, so ask someone to contact the nearest maternity
unit where there should be a midwife available who can help you and act
as a spokesperson for you.

Drugs and medications in breastmilk


It’s wise not to take any unnecessary drug or medication while you are
breastfeeding. This includes alcohol, tobacco, cannabis, cocaine,
methadone and heroin. Women who can’t stop using tobacco, methadone
or heroin can continue breastfeeding, as long as the milk supply doesn’t
diminish to a stage where the baby is malnourished. We do not have safe
levels for cocaine and cannabis so don’t take a risk. Alcohol is harmless in
small quantities but not in any greater quantities than a small drink every
so often.

When it’s necessary to take drugs for an illness or a medical condition it’s
important to get the most appropriate drug and correct information about
possible effects on your baby. It’s also important to take what you need in
order to maintain your health or to help you get better as quickly as
possible. Tell your doctor you are breastfeeding so he or she can choose
the best drug. You also need to know if your baby may be temporarily
upset, get diarrhoea or be at risk of a fungal infection while you are taking
the medication.

Drugs can cause problems either because they are harmful for the baby or
because they interfere with the body’s ability to make milk. It is now
recognised there are relatively few drugs that can’t be taken while
breastfeeding but unfortunately the reference which is widely used at the
current time still contraindicates most drugs. This means that women are
sometimes not treated adequately or babies are removed from the breast
unnecessarily. It’s impossible in this book to provide detailed information
but I would like to make the point that drugs for postnatal depression,
epilepsy, diabetes and anti-coagulant drugs such as heparin and warfarin
may be safely given as misinformation about these particular drugs is
common.

The best people to check with are lactation consultants or child and family
health nurses as they have detailed references.

Breastfeeding from one breast


When there is only one breast to feed from because of the removal of all or
part of a breast, breastfeeding can still work well providing the remaining
breast is normal. If you only have one breast to use you may feel
apprehensive about breastfeeding when you are doing it for the first time.
Here are a few tips:

Confidence is everything. Think about all the women who breastfeed


twins. Encouragement from those around you and help when you need
it from an interested breastfeeding adviser makes an incredible
difference.

Difficulties and problems that might arise when feeding on one breast
are exactly the same as for women who feed from two breasts. The two
most likely to worry you in the first four to six weeks are thinking you
may not have enough milk and a sore nipple. The advice about these is
the same whether you feed with one breast or two.
Feeding after implants or breast
reduction surgery
Being able to fully or partially breastfeed after augmentation or breast
reduction surgery varies a lot according to the way the surgery is
performed, so it is best to decide to breastfeed and wait and see what
happens. While an optimistic and positive approach is desirable, I am
aware of the heartbreak involved when women are given completely
unrealistic expectations by well-meaning breastfeeding enthusiasts. Some
women do breastfeed well but others only manage to breastfeed to a small
extent. Nevertheless, they find the experience fulfilling, and not
disappointing, as long as they haven’t been led to hope for the impossible.

Breast implants: As there is usually little disruption to the ducts or


nerves in the nipple or breast, breastfeeding proceeds normally for
many women who have had implants, but care needs to be taken to
drain the breasts well, so let your baby have the breast frequently.
Research suggests there may be problems related to breastfeeding after
silicone implants. More research is needed to verify this. At this stage it
seems wise to take further advice if you wish to breastfeed following
breast implant surgery that involves the use of silicone implants.

Breastfeeding following breast reduction surgery is also possible and it


never should be assumed that it won’t work, but it is much harder to
establish and maintain breastfeeding for any length of time. Most
women who breastfeed following breast reduction surgery also use
some formula. The formula can be given by bottle or Supply Line (see
chapter 8). When this is carefully done, breastfeeding can be
maintained and often the use of formula stopped when food from a
spoon is introduced.

Diseases and breastfeeding


Jaundice and breastfeeding
(See Jaundice, chapter 10.)
Phenylketonuria and breastfeeding
Phenylketonuria is an ‘inborn error of metabolism’ and a rare condition
affecting one in 10,000 births in Australia—in which the baby cannot
tolerate normal amounts of protein. Special milk and a diet supervised at a
metabolic clinic in a children’s hospital is essential but it’s important to
know that breastfeeding can usually continue as well, under supervision.

Human Immunodeficiency Virus (HIV) and


breastfeeding
Research around the world strongly suggests that HIV, the virus which
causes Acquired Immune Deficiency Syndrome (AIDS) is passed in
breastmilk sometimes. It is still not clear why some babies are infected
from breastfeeding and others aren’t. Many women who are HIV positive
breastfeed without infecting their babies, however, when formula feeding
is a safe option it is now considered wise for women who are HIV positive
not to breastfeed. When formula feeding can’t be done safely, it is best to
breastfeed.

Hepatitis B
Women who are Hepatitis B carriers may breastfeed safely once the baby
has been immunised; immunisation is commenced straight after birth.

Hepatitis C
Evidence at the time of writing this book does not suggest that Hepatitis C
is transmitted through breastmilk, so breastfeeding is safe for the babies of
women who are Hepatitis C carriers.

Baby won’t take a bottle


Many breastfed babies are understandably not keen on using bottles. Some
babies obligingly drink from breast or bottle which makes life easy,
especially for times when mothers aren’t there.
Others will drink some things from bottles and not others—for example,
expressed breastmilk but not formula.

A few make life interesting for their mothers by drinking from a bottle at
some times but not at others and give no clue as to why or when they are
likely to oblige or refuse. An appreciable number adamantly refuse a teat
and bottle no matter what’s in it. Sometimes this happens even when the
baby has been having regular bottles from a young age so making an effort
to avoid bottle refusal by giving a bottle a week from an early age doesn’t
work for everyone but it might help.

Lots of women breastfeed and never use bottles. Bottles are not an
essential part of baby feeding. Their main value is convenience and the
first thing to do is work out why you want your baby to take a bottle then
decide what your options are if she keeps refusing. Here are some reasons
why you might want your baby to drink from a bottle:

Pressure from those around you who tell you a few bottle feeds will
make your baby sleep better at night (not a valid reason—it won’t make
any difference);

A rest from the breast;

Occasional times when you’re not there (a night out, shopping, the
dentist and so on);

Regular times when you’re not there (part-time paid work, voluntary
work, study and so on);

Full-time paid work;

Early weaning because of breastfeeding difficulties.

What can you do when your baby refuses to drink from


a bottle?
Changing bottles, teats and brand of formula hardly ever makes any
difference. When babies are ready to accept a bottle in general, any type
of bottle or teat and any brand of formula will be accepted. You might
like to try a few different products, but it’s not worth buying out the
pharmacy.

Try once a day, at the same time every day, when your baby is hungry
but not over-tired and hysterical. Make sure it’s several hours since her
last breastfeed.

Starting to give the bottle while she is half asleep might help.

When possible, have someone other than you offer the bottle. Persist for
as long as you or they can, even if it means trying on and off until the
next feed—if you succumb and give a breastfeed quickly you are
unlikely to get anywhere.

Changing the position from the breastfeeding position helps. Try sitting
your baby in a portable baby chair opposite you or feed while you walk
and talk to her.

Warming the teat might help.

Painful options—the last resort


If time is running out and it is absolutely essential that your baby uses a
bottle, the only way left, unfortunately, is to not feed your baby until she is
so hungry she takes a bottle. Naturally this is painful for you and your
baby, but there are rare times when there is no other choice. There are
several ways of tackling this:

As long as your baby is well and healthy try leaving her and the bottles
with your babysitter. Obviously you need a skilled babysitter willing to
give it a go. Grandmas are sometimes the answer. Fathers can also be
invaluable for this as they are often more consistent and persistent so
the baby responds.

If this does not work, unfortunately the only other thing to do is to


withhold the breast until she drinks from the bottle—this might take up
to twenty-four hours and usually means weaning as giving some breast
and some bottle simply won’t work.

When there is absolutely no other option, a mother and baby centre can
help by being with you, making sure your baby is all right and assisting
you with weaning if weaning is necessary. If you do this at home,
please have someone with you for moral support and practical help. It is
advisable to give your baby some fluid during the process, either from a
cup, spoon or dropper or go back to the occasional breastfeed if you
have to.

Avoiding the painful option


When you are faced with this dilemma it’s a good idea to reassess things
and work out how essential it is that your baby uses a bottle. A rest from
the breast, occasional absences and regular times when you’re not there
can be managed by using a cup, teaspoon or dropper and letting your baby
wait until you come home. Healthy breastfed babies can wait five to six
hours for a feed. You are likely to find your baby is not looking for a feed
nearly as often when you’re not around. Alternatively, when your baby is
very young you might decide to take her with you.

Trying to make a well-fed, healthy, breastfed baby drink from a bottle


when she doesn’t want to so she’ll sleep better at night is a pointless,
stressful exercise which will make no difference to her sleeping patterns,
so ignore suggestions like this. Once your baby is old enough to eat food
from a spoon, breastfeeds can be replaced with food and a cup. A breastfed
baby never needs to be forced to use a bottle after five or six months of age
unless there’s some sort of unavoidable emergency (rare) or for nutritional
requirements because the milk supply is very low and the baby refuses
food and a cup.

FOR MORE INFORMATION


Chapter 9: Bottle Feeding Your Baby After the First Two Weeks

Chapter 10: Early Worries and Queries (heat rash, hormone rash; poo variations;
regurgitation and vomiting; Infant Newborn Screening Test)

Chapter 13: Growth and Development (rooting reflex; hands in mouth)

Chapter 14: Sleeping and Waking in the First Six Months (‘unsettled period’)

Chapter 15: The Crying Baby (normal crying patterns)

Chapter 16: For Parents (contraception and the mini pill)


Chapter 18: Feeding Your Baby (starting new food)
9

Bottle Feeding—After the First


Two Weeks
Previous chapter | Contents | Next chapter
Weaning
Weaning means stopping breastfeeding or expressing breastmilk into a
bottle, and using other food and/or fluid instead. Infant formula is the best
and safest substitute for breastmilk when babies are under twelve months
of age.

Early weaning when breastfeeding doesn’t work out


Weaning is often accompanied by feelings which you may find
unexpected. Breastfeeding is an extension of birth—the powerful physical
and emotional responses are very similar. When women plan to breastfeed
and are subsequently unable to do so for reasons outside their control they
can feel intense guilt, anger and a huge sense of loss. Alternatively other
women may find that not having to continue through insurmountable
problems and endless ineffective regimes brings great relief with the grief.

Intense grief and loss is experienced especially by women committed to


breastfeeding, who have access to good knowledge and support but who
unexpectedly experience problems no one can help them with. The
decision to wean comes after weeks and sometimes months of
perseverance and endless consultations with a range of breastfeeding
experts.

A common complaint is that as soon as they make the often agonising


decision to wean they are dropped like hot cakes by the experts they have
been seeing.

I’m not sure what the answer to this is, but it seems to me that those
involved in breastfeeding have an ethical responsibility to:

Prepare women in the ante-natal period for the possibility of


breastfeeding not working out as they plan (I believe this can be done
without setting women up for breastfeeding failure).

Ensure breastfeeding information is accurate, positive and realistic.


This means avoiding making promises that ‘everyone can breastfeed’
and that ‘all problems are solvable as long as you have access to the
right health professional’.

Learn better ways of supporting women through their grief over


weaning. It’s not good enough to say, ‘Well, never mind, you did your
best, the baby will be fine.’ If this is so, these women wonder, why is
the importance of breastfeeding stressed to the degree it is?

If you feel sad and/or angry about weaning it’s important to let it out by
talking things over with a sympathetic person who understands your anger
and grief. For some women the anger and grief last a long time and it is
crucial to have some appropriate support during this time.

How to wean
Weaning is often referred to as ‘drying up the milk’. This is an inaccurate
term as it implies weaning means a complete absence of milk. In fact,
many women find they can still express some milk months after they finish
breastfeeding. What you are aiming for when weaning is not an absence of
milk but avoiding hard, painful breasts which may lead to mastitis.

The time it takes to do this varies from woman to woman. If lactation is


not well established weaning may only take a few days, if the milk supply
is abundant it’s a good idea to plan on four to five weeks. Gradual weaning
is the most comfortable way to wean for most women; both physically and
psychologically. It also gives you a chance to think about things and
perhaps combine bottle and breastfeeding rather than completely weaning
(see chapter 8).

Start by missing one breastfeed and replacing it with formula. When you
do this you will notice your breasts become quite tender. Continue to
breastfeed as usual for the other feeds. When your breasts feel comfortable
again, drop another feed. See later in this chapter for a guide to when to
substitute the bottle for a breastfeed. The feeding times on the guide are
only approximate. Feed at the times you normally feed. Go to each stage
when your breasts are comfortable. As your milk diminishes you will need
formula top-ups for some of the breastfeeds. Medication is not used to help
the weaning process any longer as there are health risks associated with its
use.
Weaning straight after birth
Some women decide not to breastfeed at all. Resulting levels of discomfort
and breast inflammation vary a lot from woman to woman. Engorgement
and pain can be helped by oral analgesics and cold compresses or cabbage
leaves placed on the breasts.

The use of medication to help with weaning waxes and wanes.


Medications used in the past were found to have serious side effects. At
the moment a drug called Dostinex is sometimes prescribed. Dostinex
reduces prolactin (the hormone that stimulates breastmilk) and is normally
used in the general population for disorders caused by abnormally high
levels of prolactin. Dostinex comes with the possibility of significant side
effects—nausea, indigestion, drowsiness, sudden drop in blood pressure—
and sometimes doesn’t reduce the breastmilk. Bearing all this in mind I
think it is better to do without medication.

The use of cabbage leaves is somewhat controversial as there is no reliable


research supporting their beneficial effects or any scientific explanation as
to how they work. However, there is plenty of anecdotal evidence that the
use of cold cabbage leaves reduces inflammation and pain. Cabbage leaves
also reduce the milk supply so care has to be taken if they are used for
engorgement or oversupply not related to weaning.

Using cabbage leaves


Thoroughly washed and dried cold cabbage leaves are applied to the breast
and held in place with a bra. Fan the leaves around your breast avoiding
any contact with the nipples. Change leaves frequently when they become
limp and warm. When using cabbage leaves for weaning continue using
them for as long as they are needed for breast comfort. Obviously, do not
use cabbage leaves if you think you may be allergic to cabbages or if the
idea is distasteful. Stop using them immediately if you develop a rash or
itchy skin.

Sudden weaning after a period of breastfeeding


It is not always possible to wean gradually for a few different reasons.
When stopping breastfeeding quickly, you may experience full, hot painful
breasts unless your milk supply is low or not well established.

Managing sudden weaning


Wear a well-fitting firm (not tight) bra day and night.

Take analgesics (such as paracetamol) when you need to.

Apply cold compresses or cabbage leaves.

Gently hand express three times a day for four to five days, twice a day
for two to three days, then once a day if you need to. Whenever
possible, hand express under a warm shower. You do not need to
express much milk—the expressing is for comfort only.

An intensely painful breast accompanied by illness and fever is a sign


of an infection. See your family doctor as soon as possible.

Once your baby is having formula for all her feeds you may have lumpy
breasts for some time. As long as they are not painful ignore them.
Time Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6

6 am Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed Weaned

10 am Breastfeed Bottle Bottle Bottle Bottle Weaned

2 pm Breastfeed Breastfeed Breastfeed Bottle Bottle Weaned

6 pm Bottle Bottle Bottle Bottle Bottle Weaned

10 pm Breastfeed Breastfeed Breastfeed Bottle Bottle Weaned

Breastfeed
2 am Breastfeed Breastfeed Bottle Bottle Weaned
(+ top-up)

Your hormones may take some time to return to normal. Some women
begin to ovulate as soon as they wean, others find the return of ovulation
and menstruation is delayed by several months. If you are taking the mini
pill (progesterone only) you should be aware that the chances of
conceiving increase as the breastfeeding decreases so it’s advisable to use
alternative contraception if you wish to avoid pregnancy. It is safe to start
the combined pill (oestrogen and progesterone) while your baby is still
having some breastfeeds. The combined pill also helps diminish the
breastmilk.
The decision to wean is yours. Try not to let anyone pressure you either
way. If breastfeeding is important to you, try every avenue before you start
weaning. The correct advice at a sensitive time can make the world of
difference. Avoid hasty decisions. A nutritional emergency in a healthy
baby that requires sudden change is very rare.

Feeding patterns
As your baby grows, the amount of milk taken at each feed increases and
the number of bottles gets less. (See the chart in chapter 7.)

When your baby is emptying all her bottles go to the next recommended
amount. Remember there is a range of variation on amount of milk and
number of feeds at any age. Giving your baby what she wants, when she
wants it, works well most of the time but occasionally small problems
arise which need a slightly different approach.

Babies who drink too much


A number of babies seem perpetually hungry, rapidly increasing the
amount they drink until they are having a lot more than what is
recommended for their age and weight.

You might find that she drinks a lot between three and eight weeks of age
then the amount she drinks gets less and she doesn’t seem as hungry.
Alternatively, she might continue to want endless bottles of 240ml without
any sign of slowing down. What can you do?

Check that you are making up the feeds correctly. If the formula
mixture is too strong your baby might be thirsty, not hungry. If the
mixture is too weak your baby is needing extra because she is hungry.

Is your baby really hungry? Babies who don’t sleep much want to suck
a lot for comfort, not food. Settling techniques, instead of constant
bottles, can help to cut down excessive feeding. Don’t forget, crying
and sleeping difficulties in a baby are usually separate issues to feeding,
whether the baby is breastfed or bottle fed.
Babies who drink too little
Some babies are small eaters who are invariably healthy and developing
normally but exist quite happily on half the recommended amount for their
age and weight.

If your baby is like this, you are probably finding that once her immediate
appetite is satisfied she loses interest and starts to cry when you try to keep
giving her the bottle. She may have been like this from birth or has
gradually become more fussy as time goes by. When you’re a mother, you
can have a deep emotional investment in feeding your baby. If your baby
fusses and doesn’t drink what she’s ‘supposed’ to drink, it’s very easy to
start thinking it’s your fault and feel anxious, guilty and even angry. It’s
normal to feel like this but unfortunately it adds to feeding-time stress. As
well, you may be contending with people around you urging you to make
her drink more which doesn’t help. What can you do to save your sanity?
Here are a few options.

Check that the hole in the teat is not too small.

Check you are preparing the formula correctly.

Look at your baby. Is she bright-eyed, alert and vigorous? Is she having
six to eight pale, wet nappies a day and having a good poo every so
often? If so:

Take it easy—accept that she is a fussy eater. You cannot make your
baby drink when she doesn’t want to.

Try to have relaxed feeds. When she starts to cry and refuses the
bottle stop the feed, don’t keep trying to make her drink when she is
upset.

Offer her the bottle three- to four-hourly as much as possible rather


than little snacks every hour or so. Waiting until she’s really hungry
means she’ll drink more.

When you can, feed her when she is sleepy.

Avoid endlessly changing the formula, the bottles and the teats.
Whenever you make a change you will notice that for a day or two
things seem to improve, then go back to how they were. This tends
to increase everyone’s anxiety and make things worse.

Babies who drink less may put on less weight. This is not a problem for
your baby as long as she is well and keeps gaining around 500 grams a
month. If she has no weight gain for a month or so or loses weight, a visit
to a paediatrician is a good idea.

Starting food from a spoon early (around three months) usually doesn’t
make a lot of difference as fussy drinkers are often fussy eaters so you end
up with double trouble. Occasionally a fussy drinker loves food from a
spoon which is a great relief for everyone because the amount she eats
from a spoon makes up for what doesn’t go down by bottle. If you try food
from a spoon, make sure you give the bottle first as one or two little
mouthfuls of food may mean she drinks less from her bottle than usual.

Hard poo
Generally babies who are having formula produce poo which is something
like plasticine or play dough in texture and is a khaki sort of colour, but
there are a few variations on the theme so don’t worry if your baby’s poo
doesn’t quite fit this description. These babies tend to go only once every
day or two.

Constipation is not how often your baby goes but what it’s like when she
does go. If her poo is hard and dry like a ‘rock’ or small pebbles it means
she is constipated. Some babies having formula do get constipated for a
while until their bodies adjust.

No brand or type of formula can guarantee that your baby won’t get
constipated. Because all formula varies slightly, some babies may become
constipated on one brand and not another. Constipation problems are
hardly ever prevented or solved by using or changing to a particular brand
of formula. When your baby is having formula it is nice to see a poo every
day or so as that’s a way of keeping check of what’s going on. If she
hasn’t been for several days or if she does a hard, dry rock, action needs to
be taken! This might happen in the early weeks if she has been having
formula since birth; however, with improvements to formula this is less
likely to happen now than once was the case.

What do you do?


Remember plasticine or play dough poo is normal—no need to do
anything.

Make sure you are making up the formula correctly. Formula that is too
strong causes constipation—don’t forget, water first, then add the
powder.

First, try offering your baby extra drinks of cooled, boiled water a
couple of times a day. This will help—if she will drink it.

Here is an option for you to follow, for a maximum time of twenty-four


hours only, if extra water doesn’t do the trick:

Put one small teaspoon of sugar into every bottle of formula until
your baby does a good poo. When she poos, stop the sugar. Stop the
sugar anyway after twenty-four hours—she will probably do a poo
soon after the last bottle in the twenty-four hour period. A little sugar
is a good way to stimulate her bowel and get things moving and far
better than resorting to medications and suppositories.

After the sugar regime, give a little diluted prune juice every day for
a while until your baby is pooing well.

Prune juice is a fruit juice made from dried plums which has an
ingredient that stimulates the bowel. It is available in the
supermarket or alternatively you can make your own by gently
boiling about twelve prunes in 600ml of water; don’t add sugar.
When the mixture is a nice dark brown, strain off the water. Dilute it
half and half with cooled, boiled water—try 30ml of prune juice
with 30ml of water. This may be strengthened or weakened or you
may give more or less according to what you think your baby needs.

Occasionally, before you know it a crisis situation happens and your


baby is so distressed immediate action is needed. If this happens it is
necessary to give an infant suppository to bring quick relief. After
the event start one of the regimes suggested here or see your family
doctor or child and family health nurse for advice.

Sudden bottle refusal


If your baby suddenly refuses her bottle it might be a sign she is not well,
especially when it is accompanied by floppiness, fever, diarrhoea or
sudden unusual vomiting. Even when none of these symptoms are present
see your family doctor to rule out a sore throat or an ear infection.

Bottle refusal can be caused by the smell and taste of chemical sterilant, so
if your baby is well and you can’t think of any other reason for her to
refuse the bottle, try boiling the bottles and teats instead of using a
chemical.

Changing the formula


Formula is constantly changed, often at the advice of health professionals,
but changing formula will rarely change your baby’s health or behaviour—
it simply gives you something else to think about for a day or two.
Changing the type of formula once may sometimes be warranted in special
circumstances where there are clear indications for doing so (standard to
hypoallergenic to low lactose and so on) but constantly swapping brands is
pointless apart from a cost advantage.

Juice, water and vitamin supplements


Full-term babies having formula need none of the above unless
constipation is a problem or the weather is very hot in which case you
might like to offer extra water between feeds. Vitamin supplements are
unnecessary as formula contains adequate amounts of all nutrients.
Premature babies are given supplements for the first three to four months
after birth to make up for their lack of stored vitamins and iron.

FOR MORE INFORMATION


Chapter 8: Breastfeeding Your Baby After the First Two Weeks (hand expressing; mastitis)

Chapter 14: Sleeping and Waking in the First Six Months (


‘growth spurts’ or the six weeks change; the unsettled period; options for settling)

Chapter 16: For Parents (contraception)

Chapter 18: Feeding Your Baby (starting new food)


10

Early Worries and Queries


Previous chapter | Contents | Next chapter
Small things cause anxious moments for parents in the early weeks after
birth. Most of these things are normal and have a simple explanation—or
are easy to treat if treatment is needed. If you are ever unsure of what is
happening, ask for help from your child and family health nurse or family
doctor.

Baby skin
Babies rarely have a flawless complexion in the first three months, so
don’t be alarmed when your baby breaks out in a variety of rashes and
blotches. Strange rashes and dry skin during this time are usually due to
your baby’s body adjusting to her new world and to hormones which are
passed from you to your baby just before birth. They are unlikely to be
caused by allergies, breastmilk or formula, your diet or in fact anything
you are doing.

Dry skin
Most newborn babies have patches of dry, flaky skin ranging from barely
noticeable to what looks like a shedding of the whole outside layer of skin.
Dry skin on young babies is not a dry skin condition—it is the layer of
skin that came in contact with the fluid inside the womb. A moisturiser
helps the appearance of the skin, but eventually the flakiness disappears
whether you use a moisturiser or not.

Peeling skin is common in the groin of newborn babies. It won’t worry


your baby at all so don’t confuse it with nappy rash. Peeling skin in the
groin doesn’t need treating, but if you would like to smooth on a soft
cream until it goes, that’s fine.

Newborn rash
The newborn rash appears soon after birth and is a blotchy red rash which
is all over the baby’s body. Some of the blotches have a white spot in their
centre. The newborn rash is caused by things being next to your baby’s
skin that she is not used to such as clothes, cuddlies and nappies. It comes
and goes and is more obvious when your baby cries. The blotches won’t
worry your baby and disappear quickly so no treatment is necessary.

Heat rash
Heat rash refers to those tiny red dots that are mostly over your baby’s
head and neck but you may notice it anywhere on her body, especially
where two lots of skin come in contact. The tiny red dots often join up to
form red splotches. Heat rash is common in babies and toddlers up to the
age of three, especially when the weather gets hot; however, it appears in
most newborns regardless of the weather while their bodies adjust to the
relatively hot, humid environment after life in the temperature-controlled
womb. As your baby’s body sweats less and her skin gets used to having
sweat on it, the rash fades. Overdressing sometimes contributes, but many
babies of this age get heat rash no matter how they are dressed or what the
weather is like. It does not cause itchiness or distress in young babies and
does not need treating.

Sweating
It is normal for babies to be sweaty little people. Their bodies
overcompensate for their new environment, so you are likely to notice
your baby’s head gets very damp while she is feeding and that the sheet in
her bed is quite damp at times when you pick her up. Sweaty heads and
bodies are common up until three years of age.

Hormone rash
Hormone rash is the rash still sometimes known as the ‘milk rash’, which
is unfortunate as the rash has nothing to do with your baby’s diet. The
exact cause is unknown but thought to be due to the high levels of
hormones passed from mother to baby during labour, stimulating the oil-
producing glands (the sebaceous glands) and causing pimples. Your baby’s
skin may feel crusty and there may be crust on her eyebrows, head and
ears.

Hormone rash and heat rash are usually around at the same time all mixed
up together and the combined effect can be a bit alarming when there’s a
lot of both. Unless it’s very severe, which is unusual, it needs no treatment
as it won’t bother your baby at all—she’s too young to look in the mirror!
The rash disappears like magic at around three months, leaving behind the
fine, clear baby skin you see in advertisements in magazines or on TV.

Neither of these rashes has anything to do with your baby’s crying and
sleeping patterns.

Cradle cap
Cradle cap refers to the formation of crusts on the scalp, eyebrows and
behind the ears. The exact cause is unknown, but cradle cap is an oily skin
problem not a dry skin problem. The underlying cause can’t be treated so
treatment of cradle cap involves softening the crusts as they form so they
can be painlessly removed. Crusts can persist on the scalp well into early
childhood for some children, but for the majority of babies it stops
happening between six and eight months, and often before.

Suggestions for softening and removing the crust are many and varied.
Here are the ones I find easiest to use and most effective:

For eyebrows and/or behind ears try frequent applications of sorbolene


and glycerine. When you’re at home, massage a little into your baby’s
eyebrows and behind her ears every time you change her nappy so it
becomes part of your routine. At bath time wipe her eyebrows and ears
gently with a flannel to remove the softened crust.

For a crusty scalp try petroleum jelly. This is very effective for babies
who don’t have much hair but trickier for those with a lot of hair.
Massage some petroleum jelly into your baby’s scalp before bed, leave
in overnight and wash out with soap the next day at bath time,
removing any crusts that are soft enough to remove easily. You have to
remove the crusts—they don’t just float out. After the bath brush your
baby’s head with a soft brush.

Make sure you massage the petroleum jelly into your baby’s scalp, not her
hair, and don’t overdo it or there’ll be a terrible mess!

If there are a lot of crusts building up and it’s very difficult to soften and
remove them ask your chemist to mix you a combination of 2 per cent acid
sal and 2 per cent sulphur in sorbolene and glycerine. Use in the same way
as the petroleum jelly.
Cradle cap is a nuisance because it can’t be prevented and time is the only
cure. If it is mild and you don’t mind the look of it you needn’t do
anything—it is harmless. If a lot of crusts are building up, softening them
and removing them regularly prevents a build-up which looks unsightly
and can get quite smelly.

Bright red rash around the anus


Most breastfed newborns poo a lot, especially in the first six weeks. Lots
of poo is quite normal, but you might find your baby gets a bright red rash
around her anus. Occasionally there may even be a little bleeding. It is
unlikely this rash will bother your baby and once she stops pooing so
much (around six weeks) the rash goes away. Until this happens a good
barrier cream helps protect the skin. Put a generous dob on the anal area at
every nappy change.

Baby impetigo
Occasionally newborn babies develop blisters or pimples filled with thin
pus—usually on the lower part of the abdomen under the navel and/or in
the nappy area. They burst and leave a raw area. The blisters and pimples
are caused by a staphylococcus infection and spread if they’re not treated
so see your family doctor. In the early stages they can sometimes be
treated successfully by applying povidone-iodine or an antibiotic ointment
but usually oral antibiotics are needed.

Tiny movable lumps


Tiny, movable lumps are sometimes felt under the skin anywhere on a
baby’s body, including the head. They are harmless and are likely to be
either a small sebaceous cyst or a lump caused by burst fat cells. Neither
needs treating.

Nappy rash
Nappy rashes don’t happen because mothers do the wrong thing, although
I’m sure many are made to feel this way when they ask for help to treat a
rash.
‘Do you use plastic pants?’ ‘What sort of nappies do you use?’ ‘How often
do you change her nappy?’ are all questions you’re likely to become
familiar with in the next year. Advice to stop using plastic pilchers or to
leave your baby out of nappies for long stretches of the day and night is
impractical and unnecessary and usually offered by experts who have
never looked after babies for any length of time.

What is nappy rash?


Nappy rash is a general term which refers to the variety of red, blotchy and
sometimes spotty skin conditions babies get in the nappy area. Nappy rash
may appear on the genitals, around the anus, on the buttocks, on the lower
part of the tummy which is covered by the nappy, in the groin and on the
thighs. Sometimes the whole nappy area is affected and sometimes the
rash may only appear on one of the above areas.

What causes nappy rash?


The combination of wetness, friction and heat that is generated inside a
baby’s nappy makes the risk of a nappy rash ever present. The chafing and
sogginess damage the protective layer of skin causing an area of rough,
red, hot blotchiness. Once the skin becomes damaged it often becomes
infected. The most common infection in the nappy area is Candida, which
is a fungus. Most nappy rashes have a fungal infection as well as the
original rash within seventy hours if the treatment to remedy the original
red bottom is not successful.

Nappy rash can also be caused by medication, viral diarrhoea or


occasionally when a new food is introduced into the baby’s diet.
Sometimes rashes are caused by creams, washing powders or disposable
nappy liners.

No miracle cream or powder exists which prevents or cures all rashes.


Frequent nappy changing helps avoid red bottoms but some babies are
prone to nappy rash no matter how often the nappy is changed and will not
be free of nappy rash until they are out of nappies.

Claims are made by disposable nappy manufacturers, and supported by


some dermatologists, that disposable nappies have a place in preventing
and treating persistent nappy rash. Good quality disposable nappies use
modern materials that keep the skin dry and as they are thinner than cloth
nappies are less likely to result in overheating. However, I cannot say that
in my work I notice any great difference between the incidence of nappy
rash whether cloth or disposable nappies are used. Successful treatment of
nappy rash is most likely when a correct diagnosis of the rash is made. So
if your baby’s bottom doesn’t respond quickly to simple measures it’s a
good idea to seek help from a nurse or doctor before buying out the
pharmacy.

Some general nappy rash tips:


Frequent nappy changing helps avoid prolonged skin contact with urine
and poo and so minimises wetness, friction and overheating.

Washing of the skin in the nappy area at every change to ‘keep the skin
scrupulously clean’ increases wetness, is irritating to the baby’s skin
and wipes away the natural protective secretions. If you are not treating
a nappy rash, routine use of a moisturiser to both clean and keep the
skin supple is recommended. Combined sorbolene and glycerine or
aqueous cream in a pump pack is ideal. Use with a tissue to clean up
after a wet or pooey nappy.

If your baby has a rash and you are using a prescribed medicated cream,
discard all other powders, moisturisers or creams. When your baby is
just wet, pat dry with tissue. If she does a poo, clean using a damp
tissue then pat dry. Use only the medicated creams for seven to ten days
or until the rash is gone. If the rash does not improve markedly in three
days then let your nurse or doctor know.

Pre-moistened baby wipes are convenient to use when you are out and
about but avoid them if your baby develops a nappy rash until the rash
is better because they sting and tend to dry the skin out even more.
Always pat the skin dry after using baby wipes as they leave the skin
very wet, causing extra friction.

Nappy rash in the first three months


Nappy rashes in the first three months mostly cure themselves or respond
to simple treatment. Newborn babies often have a heat rash in the nappy
area and on the lower part of their tummy which is covered by the nappy.
This usually clears quickly of its own accord. Cornflour or zinc and starch
powder helps. When using powder, put some in a saucer then apply with
your fingertips rather than shaking it out of the container—your baby
might inhale the powder.

Many red bottoms respond well to one of the barrier, healing creams
available. When one of these preparations doesn’t work it often means a
fungal infection is present and needs an anti-fungal cream to clear it up.
When you use medicated creams make sure there is no other cream or
powder on the surface of the skin as this stops the medicated cream from
working efficiently.

Red patches
Red patches are often present on babies’ eyelids, between their eyes on the
bridge of the nose or on the forehead and on the nape of their neck.
Occasionally they are also on the nose or top lip. The official name for red
patches is ‘storkbeak marks’ and they are caused by collections of tiny
blood vessels, highly visible underneath babies’ fine skin, which is half the
thickness of adult skin.

Storkbeak marks fade slowly, taking up to a year to finally disappear, and


are always much more visible when your baby cries.

Birthmarks
Birthmarks come in a variety of colours and shapes. The common ones are
listed below. Unusual birthmarks need a trip to a skin specialist to have a
name put to them and to discuss the likely outcome.

Moles
Moles are brown marks, come in a variety of shapes and sizes and often
don’t appear until the baby is six weeks old. Some are coffee-coloured and
look as if they are painted on, others are dark brown, some are raised and
sometimes they are hairy. Moles may be anywhere on the body and they
are permanent.
Strawberry marks
Strawberry marks are very common and are caused by red blood cells
escaping from the blood vessels. Strawberry marks are not present at birth
but appear some time in the first six weeks. They are bright red, soft
swellings with often a blue appearance around the edges of the larger ones.
After they first appear they have a period of growth until the baby is about
nine months old then they just sit there until some time late in the second
year when they begin to disappear. Most strawberry marks completely
disappear by three years of age. Strawberry marks surface anywhere on the
body—sometimes in the most unlikely places like inside the mouth, eye or
on the genitals. Large strawberry marks, or strawberry marks in tricky
spots—inside a mouth or nostril for example—need advice from a
paediatrician or dermatologist about the best ways to manage things until
they start to shrink.

Mongolian spots
Mongolian spots are caused by accumulations of pigment under the skin
and look like bruises. Mongolian spots are harmless and found on the skin
of babies who have olive or dark skin. They are present at birth but
occasionally appear for the first time as late as three months. They fade
during the first three years.

Milia
Small ‘whiteheads’ often found on babies’ noses at birth are called milia.
They are caused by blocked sebaceous glands and are usually gone by four
to six weeks. Don’t squeeze them!

Blue patches and veins under the skin


Your baby’s skin is very thin, which makes the veins under the skin very
easy to see. You may notice a blue vein across the bridge of her nose and
small blue patches on her body. Fine baby skin is also the reason for the
blue tinge around her mouth where there is an abundant blood supply and
has nothing to do with ‘wind’—goodness knows where that piece of
folklore came from. It’s time health professionals stopped perpetuating the
myth.
Blue baby hands and feet
Blue hands and feet are nothing to worry about as long as your baby is
otherwise well. Tiny extremities often feel cold even in a warm
atmosphere and are due to an immaturity in your baby’s circulation. You
will find her hands and feet quickly turn pink again when she wakes up,
cries and moves around. Baby hands and feet are often very sweaty
because the large numbers of sweat glands on the skin surface of the hands
and feet are all over-reacting to the new environment.

Mottled skin
Mottled skin with a blue hue is quite normal and due to immature
circulation of the blood. Premature babies frequently have very noticeably
mottled skin.

Hairy bodies
You may be astonished at the fine fuzz of hair on your baby’s body, found
mostly across her shoulders, on top of her arms and on her back. Hairy
ears are also common. Called ‘lanugo’, this hair grows while your baby is
in the womb and usually disappears in the first four to six weeks after
birth.

Jaundice (yellow skin)


Jaundice means that your baby’s skin and the whites of her eyes look
yellow. In most cases, jaundice in newborn babies is different to the
jaundice children and adults get, which is related to illness.

A newborn baby is born with an overload of red blood cells which she
needs while she is in the womb but doesn’t need once she is born, so her
liver starts working immediately to break down the red blood cells and
excrete the left-over product which is called ‘bilirubin’. Bilirubin is one of
the breakdown products of blood and is normally processed in the liver
then eliminated from the body in the bowel motions and urine. For some
time after birth a baby’s liver doesn’t work as well as later, so the bilirubin
builds up inside the baby’s body and causes the yellow colour on the skin
and eyes.
In most babies jaundice is not harmful and the colour fades by the end of
the first week. Frequent feeding in the first days of life helps reduce this
jaundice. Occasionally, however, the amount of bilirubin gets very high
and the baby needs special treatment. As high levels are dangerous, care is
taken to make sure the bilirubin levels are within a safe range. Bilirubin
levels are checked by placing a special device on her skin or, if a more
accurate check is needed, by a blood test. Jaundice can be made to fade
more quickly by placing the baby naked under a shining bright light with
her eyes protected. The light breaks down the bilirubin in the skin and
takes the load off the liver.

Some jaundiced babies who are breastfed remain a pale yellow for many
weeks (up to twelve weeks sometimes). This type of jaundice is referred to
as ‘breastmilk jaundice’ or ‘late onset jaundice’. The exact cause is
unknown but appears to be a syndrome associated with the milk of
particular mothers. Breastmilk jaundice in otherwise healthy babies is
harmless but in order to exclude other harmful forms of jaundice a blood
test will be done to confirm the diagnosis. Once it is confirmed that it is
breastmilk jaundice no treatment is required; it is rather a matter of waiting
for the pale yellow colour to fade and disappear. There is no need to stop
breastfeeding. Women are sometimes put through needless stress and
inconvenience when they are asked to ‘take the baby off the breast for
forty-eight hours and give formula’. Ask for a second opinion if you don’t
want to do this as the only reason to stop breastfeeding for forty-eight
hours is to reassure the parents and the doctor that the jaundice is in fact
late onset jaundice and nothing more serious.

Occasionally prolonged, worsening jaundice in the early weeks is a result


of underfeeding (see chapter 6). On rare occasions, the jaundice is caused
by something serious such as an infection, a blood disorder or a liver
problem in which case the baby is cared for by a paediatrician. Again,
breastfeeding can continue either from the breast or by giving expressed
milk by tube, dropper, syringe or bottle.

Vitamin K
Vitamin K is offered routinely to all newborn babies to prevent a rare but
potentially fatal bleeding disorder in babies in the first six months. Vitamin
K is best given by a single injection soon after birth.
Infant newborn screening
Shortly after your baby’s birth she will have a heel prick to collect some
blood. The blood test is done to detect medical disorders which may be
present in apparently normal babies. The four main disorders tested for are
phenylketonuria, hypothyroidism, cystic fibrosis and galactosaemia. Some
laboratories routinely test for up to thirty other rare disorders when
appropriate.

Phenylketonuria (PKU)
This is a rare condition (affecting one in 10,000 births in Australia) in
which the baby cannot tolerate normal amounts of protein. Late diagnosis
has devastating results because high levels of phenylalanine (an amino
acid) circulating in the blood cause progressive brain damage which in the
past was not diagnosed until the problem was obvious, by which time
nothing could be done. A special milk and diet, plus supervision at a
metabolic clinic in a children’s hospital to frequently measure blood
phenylalanine levels during early childhood means these children can now
grow and develop normally. Breastfeeding can usually continue under
supervision.

Hypothyroidism
This condition is caused by a lack of thyroid hormone being produced. The
incidence in Australia is one in 3800. It is extremely difficult to diagnose
hypothyroidism in young babies because the symptoms are very subtle and
easy to miss. A delay in diagnosis results in both growth and intellectual
retardation. Early treatment with thyroid hormone leads to normal mental
and physical development. Treatment can be started as early as three
weeks of age.

Cystic fibrosis
Cystic fibrosis is a disease which causes the intestines and lungs to
produce thick mucus and affects one in 2500 babies. There is still no cure
for cystic fibrosis, but the outlook has improved tremendously in the last
few years, mainly due to an early diagnosis which is now possible because
of the Newborn Infant Screening Test.

Galactosaemia
Galactosaemia is an extremely rare disorder caused by the accumulation in
the blood of one of the sugars (galactose) found in milk. Galactosaemia is
one of the few times breastfeeding is contraindicated. Babies with
galactosaemia who receive breastmilk or cow’s milk for any length of time
will develop liver and kidney damage fairly quickly and may die. Once
galactosaemia is diagnosed the baby receives a special milk which does
not contain galactose and so prevents serious illness and possible death.

Parents are not informed of negative results, only positive. Sometimes a


second sample has to be taken. Naturally this causes anxiety but it is
usually because the first sample was not satisfactory or because of an
ambiguous result at the laboratory. The overwhelming number of these
repeat tests are negative and parents are informed of the result (negative or
positive) as soon as possible.

Heads
Your baby’s head is about a quarter of her total length so you will
probably think it looks enormous in proportion to the rest of her body. The
bones of her head are not joined together firmly at birth so her head can
shape or mould to fit through the birth canal during labour. This means
babies who are born the usual way (head-first through the vagina) often
have odd-shaped heads for a while—especially noticeable when there’s no
hair!

Babies who are born by caesarean section or who come bottom-first


usually have more rounded heads.

Sometimes babies’ heads have swollen areas caused by pressure from


labour. When it is just the skin involved it is called a ‘caput’. Swelling
caused by a caput disappears in a few days. If the bone also becomes
swollen it is called a ‘cephalhaematoma’ and takes longer to disappear.
About 20 per cent of cephalhaematomas take up to twelve months to
disappear—this is nothing to worry about and again is much more
noticeable on bald-headed babies.

Your baby’s head has two spaces where the bone is missing, called
‘fontanelles’. The fontanelle at the back of the head closes quickly and is
often not noticed by parents. The fontanelle at the front of the head is
diamond-shaped and fairly visible in most babies so parents are aware of
its existence and are sometimes nervous about touching it or washing their
baby’s head. You won’t hurt your baby by touching the ‘soft’ spot or by
washing her head as the space in the bone is covered by very tough
material. The size of the fontanelle varies tremendously from baby to baby
and can close any time from three to eighteen months. It is quite normal to
see the fontanelle pulsating and, at times, sunken. A sunken fontanelle is
not a sign of impending illness in a healthy baby unless there are other
signs and symptoms that something is wrong.

The joints in your baby’s head are movable to allow her head to adjust to
the birth canal during delivery. This is called moulding and the reason why
baby heads are bumpy and sometimes a funny shape. Strange shapes
usually right themselves during the first few months.

Lopsided heads
Many babies’ heads grow in what appears to be a lopsided way. Head
shape is a common concern for many parents, particularly as the incidence
of flatness at the back of babies’ heads has increased with the practice of
placing babies on their backs to sleep as recommended by Sids and Kids.

Here is some basic information, but I must emphasise that if you are
concerned about the shape of your baby’s head please see your child and
family health nurse or family doctor who will advise you if you need to see
a specialist doctor. It sometimes takes an expert to differentiate between
the causes of lopsided heads. The vast majority of asymmetrical or flat
heads either need no attention or simple changes as to how the baby sleeps
or is held, however a small number need surgery or time in a special
helmet.

There are four main reasons why babies’ heads look lopsided. Sometimes
the flattening or asymmetry will be a combination of one or two of the
following:
As mentioned above, the joints of your baby’s head are movable to
allow her head to pass through the birth canal during birth. This is
called moulding and is the reason why newborn heads can look lumpy
and bumpy and have a funny shape. Strange shapes due to moulding
usually right themselves during the first few months.

Some heads are lopsided because the bones of the skull are soft and
when babies sleep continually on their backs as is now recommended
the back of their head flattens. As the baby grows and becomes more
mobile and rolls around in the night, the head shape becomes more
regular. If your baby’s head is very flat as a result of her sleeping
position—and please get a professional opinion if there’s any doubt
about the exact cause of the flattening—here are some tips to help:

Alternate your baby’s head position from left to right each time she
goes down to sleep.

When your baby is awake, minimise the time she spends lying or
sitting with pressure on the flattened back part of her head. Give her
‘tummy-time’—see chapter 13—when you can. Hold her upright as
much as possible (without driving yourself bonkers).

The joints of the skull (called suture lines) gradually join and become
fixed by around six months of age, but are not solidly fused until late in
childhood. When one of the suture lines joins more quickly than the
others do, the head looks asymmetrical (lopsided). The flattening that
occurs due to this process is most common on the right side of the back
of the head. Most of these asymmetrical heads improve by themselves.
A very small number may need surgery or special helmets to correct the
shape or to allow for proper brain growth.

Sometimes the head looks lopsided because the baby holds her head
constantly to one side while looking at the other (see below).

Holding head to one side


Parents are often aware that their baby constantly holds her head to one
side while always looking to the other, especially noticeable around three
months when the baby has good head control. This is called ‘torticollis’
and varies from a mild degree of asymmetry, which is common, to a
severe degree which is not nearly so common. In the past, surgery was
often performed in late childhood to correct torticollis because the
significance of a baby constantly holding her head to one side was not
understood. Nowadays a severe degree of torticollis is almost always fully
correctable with early diagnosis followed by exercises and muscle
stretches under supervision of a physiotherapist.

The exact cause for torticollis is unknown but is thought to be a


combination of the position of the baby in the womb, some damage to the
neck muscle during birth and a lack of blood supply to a small part of the
neck muscle pre-birth.

Mild degree
Opinions vary as to whether any treatment is needed but a visit to a
paediatric physiotherapist is useful to assess the movement of your baby’s
neck and to get some information on a few simple exercises and things to
do to encourage your baby to hold her head to the other side and look the
other way.

Severe degree
A severe degree may be caused either because the baby has a very tight
muscle in her neck or because a lump is present in the muscle. The lump is
called a ‘sternomastoid tumour’ and is usually not present at birth but
appears some time later. It gets bigger for a while then disappears at about
six months. Physiotherapy treatment is the same for both and consists of
exercises and muscle stretches as well as advice about the best ways to
carry and lie your baby to enhance the benefit of the stretching exercises.

Hair
Your baby may be born with a thick crop of hair or she may have almost
none. Thick hair tends not to fall out while fine, wispy hair falls out in
patches and is gradually replaced by a new lot. Babies who sleep on their
back can have a shiny bald patch on the back of their head for a long time.

It may take months or even years for hair colour to become apparent.
Eyes
Your baby can see clearly from birth and will be very interested in human
faces, especially yours. Babies are short-sighted so as well as staring at
your face you will notice she is attracted to light and movement.

Eye colour is a fascinating topic of conversation. Eyes that go brown stay


brown so if this happens early you know what the colour will be. All other
colours can change and it may take up to a year or longer to know what the
final colour will be. Green eyes are unusual in the first year so it may take
even more than a year before the colour is obvious. I have seen very blue
eyes go brown as late as nine months.

Red streaks are often seen in babies’ eyes and are due to tiny blood vessels
bursting from pressure during birth. They disappear in a few weeks and are
nothing to worry about.

Young babies sometimes look endearingly cross-eyed because their eye


muscles are not strong enough to keep them straight (not a sign of ‘wind’).
Cross-eyes are usually fleeting, not constant, and stop happening at around
six months of age. If it is constant or persists beyond six months the eyes
need checking by an ophthalmologist or an optician.

The whites of babies’ eyes look coloured, usually a bluish hue, and often
stay this way until the age of two or three years. This is because the sclera
(the tough white covering) is half the adult thickness for a couple of years
and the blood vessels behind the sclera are easily reflected.

One eye looks bigger than the other


You might think one of your baby’s eyes looks bigger than the other—lots
of parents ask about this! Generally, if you look closely at photographs of
anyone you will notice eye size is not identical and that most people of any
age have a slight variation in the size of their eyes. It seems to be more
noticeable in babies and is often because one of the eyelids falls a little
lower than the other adding to the impression that one eye is bigger than
the other. A mild ‘droopiness’ of one eyelid is very common and usually
fixes itself in the first year.

Foreign body in eye


Babies occasionally collect a small foreign body in their eye such as fluff
or a speck of dust which just seems to sit there not causing any irritation or
distress the way it would in an adult’s eyes. The best way to remove it is to
float it out by squeezing some water from a saturated cotton wool ball over
the eye. If this doesn’t work or if your baby is distressed, see your family
doctor.

Tears
Tears can be present when your baby cries as early as four weeks or might
not appear until nine months.

Blocked tear duct (sticky eye)


About half of all babies develop ‘sticky eye’ some time in the first three
months after birth. Because it is so common parents are not given a clear
explanation of what the cause and possible consequences of sticky eyes
are.

Most sticky eyes in young babies are caused by a blockage in the ducts
which drain the eye. Sometimes the eye just waters without crustiness or
discharge but often there is a yellow discharge which is worse when the
baby wakes after sleep.

‘Sticky eyes’ in babies are usually a plumbing problem, not infectious, and
don’t harm the eye, so don’t confuse this with the highly infectious
conjunctivitis which older babies and toddlers sometimes get (usually from
rubbing mucus from their noses into their eyes during the course of a
cold).

What should you do?


Bathe the eyes when they need it. Use one clean cotton wool swab for each
wipe. Start near the nose and gently wipe out. Dry the eye in a similar
manner. You don’t need to buy sterile, normal saline from the chemist—
tap water is fine.

Breastmilk is also a useful fluid to clean sticky eyes with. If the eye is very
swollen and crusty, and bathing can’t keep it in check, antibiotic drops or
ointment are needed. Drops are easier to put in the eye but they increase
the watery effect which sometimes causes dermatitis around the eye or on
the baby’s cheek. Ointment is harder to administer but marginally more
effective. The antibiotic ointment or drops clear away the discharge and
make the eye more socially acceptable, but don’t unblock the duct, so the
eye often continues to water even after antibiotic treatment. If antibiotic
treatment is used it is limited to a week as blocked tear ducts can take a
few months to resolve and it is not necessary to continue to use antibiotics
for the entire time they are blocked. On very rare occasions the blockage is
so extreme oral antibiotics and attention from an ophthalmologist is
required.

Mothers are often advised to massage the tear ducts. Massaging involves
pressing gently but firmly up on the inside of the top of the nose where the
two small ducts from the eye meet the duct which runs down the inside of
the nose. For this to have any effect at all you need someone to show you
how to do it.

Massaging tear ducts several times a day is something mothers find


difficult to do because their baby objects and they end up feeling guilty
about ‘not following instructions’. Stop feeling guilty and don’t worry
about massaging your baby’s tear ducts. After many years of observing
lots of blocked tear ducts I have come to the conclusion that massaging the
ducts only occasionally makes any difference. The tear ducts unblock
spontaneously regardless of antibiotic treatment or regular massage. Most
ducts clear by six months of age if not before. A few older babies need the
duct probed by an ophthalmologist to clear the blockage. In an adult or
older child this is a simple outpatient procedure but as babies can’t lie still
they need a general anaesthetic. Probing the duct is left as late as possible
but usually done around twelve months of age when the blockage is still
easy to fix.

Ears
Sometimes baby ears fold forward or look creased and out of shape
because the ear tissue is very soft. It’s best not to try sticking the ear back
as doing this makes no difference, is uncomfortable for your baby and
irritates her skin—most ears correct themselves in time but if you are
unduly concerned about the way an ear sticks out have a consultation with
a paediatric plastic surgeon.

After a while you will notice your baby’s ears secrete a lot of wax. This is
quite normal—it’s the way the ear cleans itself.

Noses
Babies breathe rapidly, often irregularly and at times sound as if they have
a blocked nose. As they cannot blow their nose or clear their throat, and
their tiny airways are very narrow, normal mucus and milk accumulates
which makes their breathing sound weird to adult ears. Inhaling the fluff
and dust in the air is another reason babies sound blocked up and noisy
when they breathe. If your baby shares your room you’ll find the way she
breathes very noticeable in the middle of the night. Noisy breathing
accompanied by strange squeaks doesn’t mean your baby is at risk in any
way or she has an allergy. Ignore it if you can—there is no need to use
drops or any device to extract things from your baby’s nose.

Continual noisy, rattly breathing


A small number of babies who are otherwise healthy have continual noisy,
rattly breathing which doesn’t cause distress for the baby—only the
mother who has to live with constant comments from well-meaning people
around her. The reason for the noisy breathing is a temporarily ‘floppy’
voice box which causes the strange sounds as the baby breathes. When the
vocal cords tighten some time in the first two years the noisy breathing
stops.

Hoarse cry
Parents sometimes notice a hoarseness present when their baby cries and
feel guilty for ‘letting their baby cry for ten minutes’. In fact, babies are
prone to a certain amount of hoarseness because the tissue on the area
below their voice box is susceptible to swelling when they are young
which makes them sound hoarse at times when they cry. In a well baby
this has no significance.

Sneezing
You are probably aware that your baby sneezes a lot. Baby sneezing is due
to fluff and dust in the air and sneezing is a good way for her to clear her
nose.

Hiccoughs
Adults find hiccoughs uncomfortable and tedious but babies don’t seem to
mind them at all. A top-up at the breast or some cooled, boiled water helps
if your baby’s hiccoughs are worrying you but there’s really no need to do
anything. By the way, hiccoughs aren’t caused because of the way you are
feeding or burping your baby!

Sucking blisters
You might notice small blisters on your baby’s top lip. These are called
sucking blisters and are normally present when babies are getting all their
food from sucking. Sucking blisters are a natural condition which do not
cause discomfort.

White tongue
Babies do not make a lot of saliva until they are eight to twelve weeks old
so they frequently have milky-looking tongues when they are very young
because there’s not a lot of saliva to clean the tongue. When they are
having formula the white tongue looks quite thick.

N.B.: White tongue and sucking blisters are often confused with thrush.
Thrush in a baby’s mouth appears as patchy, white spots on the inside of
the lips and cheeks. The patchy spots cannot be removed by wiping.
Thrush rarely causes babies discomfort unless it is left untreated for a long
time and gets to the inflamed, bleeding stage. If you are unsure whether
your baby has thrush or not, see your child and family health nurse or
family doctor.

White spots on gums


Raised, white pearly spots are sometimes seen in the roof of babies’
mouths and on their gums where they are often mistaken for teeth. These
small cysts tend to pop out on the side of the gum, are not related to teeth
in any way and are not the reason why your baby is going through an
unsettled stage. Raised white spots appear on and off during the first year
and disappear as mysteriously as they arrive.

Tongue tie
Tongue tie refers to a condition where the baby’s tongue is attached to the
floor of the mouth rather than floating free. Mild tongue tie is very
common, tends to correct itself and is unlikely to cause any problems with
sucking, eating or talking. Babies or children with more severe tongue tie
who have difficulties with sucking, eating or talking may need surgical
release of the tongue after careful evaluation of the anatomy by a
paediatric surgeon. It is important that severe tongue tie is released. As
well as problems with sucking, eating and talking, serious tongue tie
causes tooth decay from a young age because the anchored tongue is
unable to clean the mouth and teeth effectively. Severe tongue tie needing
surgical intervention is not common and more likely to be found in
families where there is a history of the condition.
(See Tongue tie and breastfeeding, chapter 6.)

Lumps in the jaw


You may feel lumps under the skin on your baby’s jaw or cheekbone.
These are due to fat cells bursting during labour and more likely to present
after a birth with forceps. The lumps are harmless and disappear in a few
weeks.

Lumps like small peas on the back of


the neck
Small, movable lumps behind a baby’s ears or on the back of the neck are
common and normal. They are enlarged lymph nodes and are not
significant unless they are large, tender or warm to touch, in which case
see your family doctor.

Lots of saliva
Between eight weeks and twelve weeks you are bound to notice that your
baby starts to have a very wet mouth with lots of bubbles. ‘Teeth!’
everyone around you exclaims, but constant dribbling from the age of
three months is unrelated to the growing of teeth. All babies froth and
bubble from this age whether they grow their first tooth at three and a half
months (earliest apart from the rare baby who is born with a tooth) or
seventeen months (the latest).

Eight to twelve weeks is the time the human body starts to make saliva.
Babies don’t know how to swallow their saliva and sit around with their
mouths open all day so it all falls out! When your baby learns to shut her
mouth and swallow her saliva (some time around the age of fifteen
months) the dribbling stops.
Bodies
‘Poddy’ tummies (pot bellies)
It is normal for babies to have poddy tummies. As long as they are healthy,
well-fed and not showing any other signs of illness, poddy tummies are not
an indication of ‘colic’, ‘wind’, ‘overfeeding’, ‘underfeeding’, ‘lactose
intolerance’ or anything other than a normal lack of muscle tone, a state of
affairs that lasts well into toddlerhood.

A dimple at the base of the spine


This is called a sacral dimple and looks like a tiny hole the size of a pin-
head in the centre of your baby’s back just above her buttocks. Close
examination will reveal it isn’t a hole but a dimple. Sacral dimples are very
common and most grow out in time.

Fingernails
Staff in maternity hospitals may advise you to bite, peel or file your baby’s
fingernails; this is fine when she is very young but after the first week feel
free to cut them with a pair of scissors. Buy a small pair of blunt-ended
scissors, wait until your baby is relaxed, gently pull away the skin from
behind the nail and cut the top off the nail. When you are not used to
cutting baby fingernails it’s a bit scary at first, but you’ll be amazed at how
quickly you become good at it.

Toenails
Baby toenails look as if they are ingrown as they are very short and
embedded in the nail bed. Toenails grow up and out during the next three
years so there is no need to worry about this.

Blisters around fingernails and toenails


Sometimes the skin around the fingernails and/or toenails becomes red and
swollen and may form blisters. This doesn’t bother the baby and can
usually be treated by dabbing on some povidone-iodine. Occasionally
more severe infections need antibiotics.

Scratching
Small babies scratch their faces and it’s impossible to cut their nails short
enough to prevent this happening. Mittens aren’t a great idea as babies
prefer their hands free and the scratches heal very quickly. Most scratching
stops when the baby’s movements become a little more co-ordinated,
usually around three months of age.

Grunting
You are probably amazed at the strange noises your baby makes,
especially as you lie awake in the middle of the night unable to sleep as
snuffling, snorting, squeaking, grunting and groaning sounds fill the air.
Grunting seems to be the one that bothers most parents as there is the fear
there is a ‘blockage’ or that their baby is in some sort of pain and needs
treatment. All babies make noises in the night and all babies grunt to some
degree, some more than others—premature babies do it all the time!

Red, swollen breasts


The same hormones, passed from mother to baby at birth which cause the
hormone rash, also cause enlarged breasts in many babies (boys and girls).
It may happen to one or both breasts and varies from being hardly
noticeable to extremely obvious. Occasionally the breasts excrete a little
milky fluid. They will take six to eight weeks to go back to normal, are not
uncomfortable for your baby and although they rarely need treatment very
occasionally a breast can become infected and require antibiotic treatment.

Umbilical cord
Your baby’s cord will eventually shrivel and fall off. The time it takes to
do this varies from a few days to three weeks, occasionally longer. After
the cord falls off, expect a little discharge and bleeding to come and go for
up to three weeks. If needed, clean the navel with cotton wool and water.
Alcohol is unnecessary once you leave hospital and in fact the use of
alcohol on cords for full-term healthy babies is being stopped in many
maternity hospitals throughout Australia. Cord infections are rare but a
very strong smell and shiny, puffy red skin around the navel is an
indication all is not well. See your family doctor.

Navels that stay moist


Sometimes a collection of cells, called a ‘granuloma’, remain after the
cord has fallen off. Until these cells die a continual, sticky discharge keeps
the navel moist. The discharge is usually not a sign of an infection and
won’t harm your baby but may irritate the skin around the navel and cause
a red rash. Granulomas can persist for several months. Your family doctor
can touch the granuloma with some copper sulphate which helps it dry up,
but don’t be tempted to do this yourself as there are rare times when a
granuloma is a sign of something more complicated.

Bowel motions
The first motion your baby passes is called meconium and is a greenish,
black sticky substance which gradually changes until the amazing,
unpredictable array of bowel motions start to appear.

Mothers are often amazed at the number of times their baby does a poo in
the early weeks. It’s quite normal when you’re breastfeeding to feel as if
you are putting food in one end only to have it immediately returned from
the other. Frequent runny poo doesn’t mean your baby has diarrhoea or
your milk is too sugary or rich.

You may find your baby’s bowel motions vary a lot. They can be bright
yellow (like pumpkin), seeded dark yellow (like French mustard), dark
green and mucousy or a lovely lettuce green. None of these variations are
significant in a healthy, thriving baby.

Breastfed babies generally poo many times a day in the first six weeks.
This gradually decreases in the second six weeks until some only do a big
poo every so often. Every so often may be once every two or three weeks.
When your baby is only having breastmilk and no other food or fluid this
is absolutely nothing to worry about. Don’t compare it to adult bowel
habits and feel you have to do something to make your baby ‘go’ if she is
in this sort of a pattern.

A breastfed baby who doesn’t poo much in the first six weeks may not be
getting enough milk, although this is certainly not always the case. The
best way to check is to weigh your baby and get an idea how much weight
she has been gaining weekly since birth.

Babies who have formula usually do dark, sticky poo that looks like
plasticine.

Blood in poo
Occasionally an otherwise healthy baby passes a mucousy blob of blood in
her poo. This can happen whether the baby is breastfed or having formula
and although it is rarely a sign of anything significant you should always
check with your family doctor or paediatrician. Unless it persists or unless
other symptoms are present your baby should not need treatment or
investigation.

Cracking joints
Many parents notice their baby’s joints crack, most noticeably the knees
and shoulders. Clicky hips may need treatment (see below), but cracky
knees and shoulders are quite normal.

Clicky hips
A clicky hip means that the hip joint can be moved around easily. Most
new babies have clicky hips at birth because the ligaments around the joint
are loose which means the head of the thigh bone moves out of place
easily. The ligaments are loose because they have been softened by the
same maternal hormones that also cause the temporary hormone rash and
enlarged breasts. Clicky hips due solely to stretched ligaments are also
temporary, improve rapidly and need no treatment.

Congenital dislocation of the hip


This means the head of the thigh bone does not fit properly into the socket
because the socket is shallow. It doesn’t happen very often but when the
socket is shallow it is important the treatment to form a deep socket for the
head of the thigh bone to fit into is started as soon as possible.

Congenital dislocation of the hip (CDH) can be diagnosed by a skilled


health professional moving the baby’s legs in a special way to see if the
thigh bone can be moved out of the socket. It is tricky and sometimes X-
rays or ultrasound is used when CDH is suspected or a baby is in the high
risk group for CDH. Early diagnosis is vital to prevent lifelong problems.
The modern treatment is usually a ‘Pavlik harness’, which holds the hips at
right angles to the body and stops the baby stretching her legs out so a
deep socket is formed for the head of the thigh bone to fit into. The harness
is worn for about three months and is a highly successful way of treating
CDH. The use of double nappies for treating either clicky hips or CDH is
no longer recommended.

Feet
Baby feet often turn in and out in a funny fashion. Most of the time this is
because of the way the baby lies in the womb. These are called postural
deformities and always correct themselves either spontaneously or with
simple exercises or the use of a plaster for a short time.

A club foot points downwards and inwards and is usually a structural


deformity where the foot has limited movement. It needs immediate
attention from birth. Treatment is long-term and involves physiotherapy,
splinting and possibly surgery to get a more normal foot position.

Regurgitation and vomiting


Terminology has become a complicated issue in relation to the subject of
the throwing-up (a nice simple term accessible to everyone) that most
babies do to some extent during their first year—and occasionally beyond.
Here are some definitions to make it clearer.

Regurgitation (Reflux vomiting)


It is normal in humans of all ages for food from the stomach to flow back
up into the gullet, especially after meals. This back-flow is called ‘reflux’,
the technical name of the stomach is gastro; of the gullet, oesophagus;
hence the term gastro-oesophageal reflux is used to describe this action. In
childhood and adulthood we are unaware of it unless it causes heartburn or
other problems (nasty taste in the mouth, sore throats, coughing, sleepless
nights).

The reason the food flow goes up and down unnoticed in adults and
children is because the gullet is large enough to hold the churned up food
(isn’t this disgusting?) from the stomach and because the muscle, known
as the oesophageal sphincter, at the top opening of the stomach works
efficiently to keep the food down where it’s supposed to be.

Babies, on the other hand, because of small gullets, inefficient oesophageal


sphincters and a few other highly technical things I won’t bother you with
tend to lose the gastric contents when reflux occurs. The fact that babies’
diets are liquid, they are kept horizontal rather than vertical a lot of the
time and have their legs pushed up at nappy change time doesn’t help.

This loss of milk and later food in the first year in otherwise healthy babies
is viewed as normal and is now referred to as regurgitation, not vomiting.
Regurgitation is, by and large, harmless even when it looks like your baby
is regurgitating every skerrick of milk from the last feed.

Now we’ve sorted that out, let’s look at the regurgitation problem. It is
normal for healthy babies to regurgitate their food. Some do it a lot, others
only occasionally. Sometimes it is quite dramatic and will frighten the life
out of you as your baby returns milk in a great gush from both nose and
mouth. If the milk is returned straight after a feed it comes up the way it
went in. If it comes up sometime later when it is partly digested it is lumpy
and a trifle smelly. About half of all babies regurgitate enough to worry
their parents and complicate normal living, whether it’s a great gush or
continual splats of curdled, partly digested milk with its own distinctive
aroma, often deposited on a shoulder. Almost all babies bring up some
milk along with a burp in the middle or at the end of a feed.

The regurgitation may start soon after birth or may not start until your
baby is nearer to three months. It is often an on-again, off-again sort of
thing—just when you think it’s over it starts again. A small number of
babies have problems associated with regurgitation such as heartburn—a
rare, over-diagnosed condition—lung problems and very occasionally,
poor weight gains. See Gastro-oesophageal reflux disease, chapter 15.
All these things need special attention; however, the majority of
regurgitating babies have no ill effects from their regurgitating, apart from
the constant aroma and mess which doesn’t bother them at all. Needless to
say, being regurgitated on all day does not do much for mothers’ self-
esteem and it is a great relief when it stops happening—at about a year for
lots of babies, earlier for others.

Here are a few tips:

Regurgitation happens equally to breastfed and bottle fed babies,


although the amount of spilt milk is less from breastfed babies. Most
families with more than one baby will have one baby who regurgitates
all over the place, nearly always a happy baby with no other
complications.

There is no treatment that is outstandingly successful, so if your baby is


otherwise happy and well there is no need to worry or do anything.
Weaning or changing to a soy formula is a pointless exercise. The smell
of breastmilk returned is far more pleasant than formula and soy
formula smells the worst.

If you are bottle feeding it may be tempting to try the ‘reflux’ formula
kindly offered by thoughtful formula manufacturers in response to the
normal anxiety constant regurgitation brings. Thickened formula does
decrease the volume of milk being returned by otherwise happy babies,
so it makes the parents of regurgitating babies happy too. In view of the
fact that the baby is happy anyway, the use of thickened formula is
more for social reasons and a clean carpet than health. Thickened
formula tends to make babies constipated. Because of what I see as
their limited use I do not recommend them unless the amount of milk
being regurgitated is causing the parents a great deal of grief.

Don’t change your feeding to accommodate the regurgitation—that is,


don’t feed less often or for shorter periods if you’re breastfeeding
(posture feeding is not recommended) or dramatically cut down the
amount in the bottle if you’re using formula. It is not your method of
feeding or your technique that is making your baby regurgitate, so feed
away as if it wasn’t happening.

Helpful relatives and health professionals may advise starting on solids


to help stop the flow of milk up and out. Early introduction of food
from a spoon makes no difference, it just makes for interesting coloured
regurgitated stomach contents, especially if your baby eats avocado.

Should the milk be replaced after a lot comes back?

If your baby seems content don’t worry about replacing the milk. If she
seems to be hungry or wanting to suck some more, put her back to the
breast or give her another 60ml of formula.

Vomiting
Vomiting, as opposed to regurgitation, technically refers to a heaving
ejection of food by the stomach because of illness. Vomiting is not normal
and may be harmful. Vomiting can be caused by illnesses such as pyloric
stenosis, an upper respiratory tract infection, a urinary tract infection or
gastroenteritis. These illnesses cause signs and symptoms such as fevers,
significant weight loss, sniffles and mucus, loss of interest in feeding, dry
nappies or diarrhoea. It’s wise to get vomiting checked out unless it’s a
one-off and you’re pretty sure what’s caused it. Regurgitation is unlikely
to have any of these symptoms, but if in doubt always seek a professional
opinion.

Blood in regurgitated milk


Healthy babies who regurgitate milk with blood in it are usually breastfed
babies whose mothers have sore nipples. The colour of the blood can vary
from pink to a dark, almost black colour. When the nipples are cracked
and bleeding the reason for the blood in the regurgitated milk is quite
obvious, but sometimes there may be no visible signs of a bleeding nipple,
just tenderness. This does not hurt your baby but you will need help with
your breastfeeding.

Pink urine
A pink stain in the nappy is a substance called urates (not blood). This is
often present in the urine of young babies until the kidneys become mature
enough to filter it out. Urates in the first seventy-two hours after birth are
viewed as normal, after this time, especially if accompanied by green
‘splat’ poo, urates are indicative of dehydration. In this situation seek
advice as quickly as possible, especially if your baby is not sucking
vigorously (see chapter 6).

Transparent ‘crystals’ in urine


If you see tiny balls of clear white jelly in your baby’s urine and she is
wearing a disposable nappy it is the filling that is used in disposable
nappies to absorb moisture. It is harmless.

Genitals
The genitals of both boys and girls often look larger than life, which is
partly due to hormones and partly due to the birth process (particularly
babies who are born bottom-first).

Boys
It’s quite common for a baby boy’s scrotum to have fluid in it which
makes the scrotum look large and swollen; this is called hydrocele. As the
fluid is gradually absorbed the scrotum subsides—it may take several
months.

Normally there are two testes in the scrotum which are quite easy to feel.
Testes travel from the abdominal sac into the scrotum during late
pregnancy. If the opening through which they travel doesn’t close off, one
of the testes can appear and disappear from the scrotum, especially when
the scrotum is exposed to the cold. Eventually the opening from the
abdominal sac closes and the testicle remains in the scrotum.

Occasionally one or both of the testes never descend and so are never felt
in the scrotum. If the testicle doesn’t descend into the scrotum after one
year of age surgery is performed some time between one and three years.
The operation involves bringing the testicle into the scrotum and securing
it there. Penises come in a variety of shapes and sizes. If you are worried
about the size or shape check with your family doctor.

Circumcision: In most baby boys a piece of skin, known as the foreskin,


covers the tip of the penis. Surgical removal of the foreskin is called
circumcision. Fifty years ago circumcision was performed routinely
without analgesia on most baby boys in Australia, sometimes without
discussion with the parents. At one time baby boys were subjected to this
procedure in the labour ward straight after delivery.

While there are some medical reasons requiring circumcision most


circumcisions were not (and still aren’t) performed for medical reasons.

In the late seventies and eighties medical opinion did an about turn and
viewed routine circumcision as an unnecessary painful, non-therapeutic
procedure. Concerns about ethical and human rights issues in relation to
the removal of foreskins without analgesia and without permission were
also raised. Routine circumcision was no longer recommended and the
procedure became limited to those parents who requested it, and to
families where routine circumcision was performed for religious reasons,
for example in Jewish and Muslim families.

More recently there has been a drive by some health professionals and
researchers to re-introduce routine circumcision again on the grounds that
routine circumcision prevents Human Immunodeficiency Virus (HIV),
sexually transmitted diseases (STDs), Human Papilloma Virus (HPV),
cervical cancer in women whose partners engage in sexual practices that
put them at risk of HPV, penile cancer (rare), and lowers the incidence of
recurrent urinary tract infections in children.

This has renewed the debate about routine circumcision.The studies


supporting the claims that circumcision for all males is good preventative
medicine are conflicting and have mostly been done in poor countries with
high HIV rates, where, owing to living conditions, there is poor personal
hygiene, inadequate medical services and dodgy safe-sex education. In
industrialised countries primary prevention of HIV and STDs centres
around sound safe-sex education and appropriate public health measures
(e.g. condom use) not routine circumcision.

To see the Royal Australasian College of Physicians (RACP)Policy


Statement on Circumcision go to www.racp.edu.au The policy was
updated in 2011 and is a very clear statement.

The RACP concluded that the frequency of diseases modifiable by


circumcision, the level of protection offered by circumcision and the
complication rates of circumcision do not warrant routine infant
circumcision in Australia and New Zealand. In other words the risks of
routine circumcisions in healthy babies outweigh the benefits.

The RACP also strongly recommends that as circumcisions involve


significant pain they should be performed with appropriate analgesia.

If you want your son circumcised for non-religious reasons talk it over
with a few people so you are clear about why you want it done. Things like
cleanliness, a matching set with father or to avoid future problems are not
valid reasons either medically or aesthetically.

If you decide to go ahead, the safest and kindest way is to wait until your
son is over six months old and have it done under a general anaesthetic.

Newborn circumcisions are still performed and if this is your choice you
will probably have to make private arrangements with your doctor, as
circumcisions are now hardly ever performed in maternity hospitals. Your
baby should be full-term, healthy, gaining weight and not jaundiced. It is
normal for the tip of the circumcised penis to often look bluish in colour.

Uncircumcised penises need the same care as the elbow—none! The


foreskin should not be pushed back. It will retract eventually of its own
accord, often around three years of age. Forcing the foreskin back before it
is ready causes pain, bleeding and scarring that may cause damage
resulting in a circumcision having to be done.

Girls
Baby girls occasionally have a small amount of bleeding from the vagina,
caused by the withdrawal of some of the maternal hormones they receive
at birth. When you part the labia you will see a white discharge around the
vagina and inside the labia. This is a normal secretion—you do not have to
clean it. If the labia can’t be parted on a baby girl of any age check with
your family doctor. The labial skin on babies and toddlers is often paper
thin so the edges of the labia adhere to each other. This is a benign
condition which usually resolves without treatment so the previous
practice of applying oestrogen cream has been abandoned unless there are
complications (unusual).
Minor medical problems common in
the first three months
Hernias
A hernia in a young baby happens because a special structure needed by
the baby when she was growing in the womb doesn’t close off the way it is
supposed to after birth. One of the internal parts of the body then bulges
through the opening. The two most common places this happens are the
navel and the groin.

Umbilical hernia (navel)


An umbilical hernia is a soft swelling on the navel which becomes
noticeable when the cord drops off. Some are small, others are almost
alarmingly large.

If your baby has one you will notice when she is quiet the navel is flatter
than when she cries, at which time the bulge pops out looking like a
‘cherry balloon’. Gently pushing it shouldn’t worry your baby and makes a
squelchy sound.

An umbilical hernia is caused by an abnormal opening between the


abdominal wall and the abdomen which is present before birth to allow
nourishment to pass to the baby by the umbilical cord. Sometimes it does
not completely close as it is supposed to after birth and a small part of the
intestine protruding through is well covered with skin and tissue, so the
condition is usually harmless and rarely needs treatment. In time the
tummy muscles grow close so the bulge decreases slowly and goes away,
usually by the age of three years, if not before.

Rare conditions do exist where an umbilical hernia is partially or fully


strangulated. More rarely, abdominal protrusions in young babies can be a
sign of an abdominal defect which needs urgent repair, however, unless
these abnormalities are present even large umbilical hernias are usually left
untreated.

Applying sticking plaster or binding to the navel causes a rash, is


uncomfortable for the baby and makes no difference to the bulge.

Inguinal hernia (groin)


An inguinal hernia appears as a lump in the groin. The swelling often
comes and goes according to whether the baby is sleeping or crying. It’s a
good idea to check for the presence of a lump in the groin if your baby is
having sudden screaming attacks for no apparent reason, especially if your
baby is premature, as inguinal hernias happen to premature babies more
often than full-term babies.

This kind of hernia is caused by an abnormal opening between the


abdominal wall and the groin which is present before birth to allow the
passage of the testicle into the scrotum. The opening is present in boys and
girls (even though girls don’t have testes or a scrotum) and normally closes
a month before birth, which is why an inguinal hernia is more common in
premature babies.

Unlike an umbilical hernia, an inguinal hernia always needs an operation


to prevent complications. This is because the opening through which the
intestine protrudes is small and the muscles in the groin tight, so the blood
supply to the intestine may be cut off. Even if the lump can be pushed back
or doesn’t cause distress, it should be repaired as soon as possible. It may
repeat on the other side so both sides are repaired. Surgery is very
successful and involves one or two days in hospital.

Head colds
Colds are not common in the first six to twelve weeks because the
antibodies mothers pass to their babies protect them to some extent.
Remember, snuffling and sneezing in the first three months is not a sign of
a head cold unless there are other symptoms. Head colds are caused by
viruses which damage the mucous membranes of the nose and throat. This
is what causes the runny nose, the sore throat and eyes, the cough and
sometimes a headache and fever.

Complications from head colds such as ear or chest infections are more
common in babies and young children than in adults. As well, the extra
mucus generated by a cold seems to hang around forever, even after the
cold gets better.
There’s not a lot you can do to prevent your baby from catching a cold.
Breastfeeding helps, but breastfed babies can still catch colds. It’s difficult
to keep a spluttering toddler with a streaming nose away from her baby
brother or sister, but you can ask friends and relatives with head colds not
to come too close.

Head cold tips


Head colds without a fever are rarely helped by any of the various
medications commonly suggested. The decision whether or not to use
antibiotics can be difficult. Most head colds are caused by viruses so
antibiotics (which fight bacteria) are unlikely to do a lot. Antibiotics can
cause diarrhoea and fungal infections so their use often complicates head
colds in babies rather than having any beneficial effect. Babies with head
colds aren’t helped much by drugs which dry up the mucus. Some have a
sedative effect which is best avoided, especially in babies under six
months. Constant use of medicated nose drops increases the mucus and
may damage the lining of your baby’s nose—which leads to other
problems later—however, used occasionally, can help if your baby is too
blocked up to feed properly.

If your baby is sleeping and eating as well as can be expected given that
she is somewhat miserable and uncomfortable, there is no need to
medicate. Noisy, ‘bubbly’ breathing is acceptable as long as she is not
struggling to breathe. It’s normal for a baby with a head cold to do poo
which contains mucus and have a few mucus-filled vomits too.

Unfortunately there is no magic potion which makes colds get better


quicker. Treatment always involves relieving the symptoms. If your baby
has a badly blocked nose here are some helpful hints:

Try a vaporiser. Despite the fact that recent research shows a vaporiser
makes very little difference, lots of the parents I talk to find a vaporiser
helps. Some pharmacies have vaporisers for rent which means you can
try before you buy.

A little Vicks dabbed onto the sheet in your baby’s cot, well away from
her mouth, will help her to breathe more easily. It’s best not to put it
directly onto a young baby’s skin and to test a small amount before
rubbing it onto the chest of an older baby.
Weak saline nose drops can be used freely to wash out her nose. If you
use medicated drops try to only use them occasionally before a feed if
her nose is so blocked she can’t suck. Once the worst of the cold is over
(about a week) and your baby can suck reasonably happily again stop
using them.

If your baby has a head cold with a fever (37.5°C or above), dress her
lightly and give extra breastfeeds or other clear fluids. See chapter 25 for
more information regarding fevers.

Coughing accompanying a head cold is usually caused by the mucus


trickling down the back of your baby’s throat. If there is a lot of coughing,
check with your doctor to make sure there is no chest infection. If her
chest is clear, try some of the suggestions for blocked noses. Cough
suppressants shouldn’t be given to babies.

It’s wise to consult your doctor if you are worried or if your baby has a
fever when she is under three months. Other symptoms which need
medical attention are breathing difficulties or wheezing and feeding
problems in young babies who suddenly refuse to suck.

Bronchiolitis
Bronchiolitis is an infection caused by a virus that babies can get and is
similar (but not the same as) an attack of bronchitis in adults. It often
occurs in epidemics, especially during the winter months. The virus causes
coughing, wheezing and cold symptoms and the younger the baby, the
more potentially serious the condition, especially if the baby was born
prematurely. An attack of bronchiolitis can range from being mild to
severe. No drugs are available to destroy the virus so antibiotics are not
appropriate and treatment involves making sure the baby’s breathing is
adequate, and that the baby is eating enough to stay well nourished.

Mild cases are treated at home while moderate to severe cases need
admission to hospital, sometimes to an intensive care unit.

Bronchiolitis usually gets worse for three to four days, stays the same for
another three to four days then starts to get better, taking about two weeks
for full recovery. The cough is the last thing to go. An attack of
bronchiolitis does not mean the baby will become an asthmatic later on.
Medicating babies
A wide range of baby medications is available and large numbers of
healthy babies are given some sort of medication before they are three
months old. Most of the time the use of medication is inappropriate, not
needed and doesn’t cure the problem.

Why are drugs used so much?


Part of the delight and frustration of babies is their mystery. They can’t
talk and tell us what the matter is or how they feel, and unfortunately part
of the way we look after babies is to regard everything they do as a curable
medical condition even when what they are doing is related to their
behaviour, not their health. Parents become very anxious when their baby
is either not well or does puzzling things (like crying a lot) and often, on
the advice of a health professional, use some sort of medication in the hope
of a miraculous cure or a change in their baby’s behaviour.

Most of the time the commonly used drugs or herbal remedies have little
effect on the health and behaviour of otherwise healthy babies. At best
they are a waste of money—at worst some may be harmful, particularly
when they have a sedative effect.

There are times when medication is vital because of a chronic or serious


health problem and this should be taken care of under a doctor’s
supervision and monitored regularly; however, giving well babies drugs is
often unnecessary so here’s a few things to think about before you do:

Try to think through why you are giving the drug. Is it for a clearly
defined physical symptom or is it because of the way your baby is
behaving? For example—a fever is a clearly defined physical symptom.
Grunting, going red in the face and drawing up legs is a normal way for
babies to behave. These are not clearly defined physical symptoms of a
medical problem.

If you are advised or prescribed medicine for your baby ask the
following questions: What’s in the drug?; What are the possible risks
and side effects?; What condition are you treating and how does the
drug work?; What are you hoping to achieve by giving my baby this
drug?; What are the chances of a positive response?; Is this drug really
necessary?

Read the label. Find out what is in the medication. Generally,


medication which contains a single drug is preferable to those which
combine several.

Give the medication from a dropper or a teaspoon—not in your baby’s


bottle or in her food.

As your baby grows and you learn more about her normal development
and behaviour, you will become more confident and manage without
relying on unnecessary medication, especially when you have seen her
through one or two minor illnesses.

When to call the doctor


Often new parents don’t have a doctor as having a baby usually happens at
a time in life when people are generally well and have no need of medical
care. Once a few babies start to arrive, however, a doctor you know and
trust is a very worthwhile investment. Lots of doctors have special areas of
interest that they have given extra time, attention and study to, so look for
one who has an interest in paediatrics and family medicine.

Deciding when to take your baby to the doctor because she is unwell or
behaving strangely is a dilemma for most new parents (and often for those
not so new). A few guidelines follow.

There are often times when a baby has slight behaviour changes or mild
symptoms which do not need urgent attention. Frequently the problems
resolve themselves quickly or you find out they are not problems at all but
normal features of babyhood.

Babies in the first twelve months have a whole range of interesting strange
habits which adults try to interpret, often coming up with quite
inappropriate conclusions. Similar strange actions and habits are common
to all babies and are usually reflexes, part of normal development or a
baby’s way of practising skills. For example, playing with and pulling ears
is one of these actions and not a sign of ‘teething’ or an ear infection.
If your baby is thriving, active and wetting and pooing normally it’s
unlikely there’s anything wrong, but always seek help when in doubt.
Sometimes situations do arise that need immediate medical attention. Here
they are:

A sudden loss of interest in feeding, especially when it’s a young baby


who won’t suck.

A constant high fever that doesn’t respond to paracetamol and taking


off some of the baby’s clothes. Any fever in a baby under three months.

Sudden vomiting and diarrhoea for any length of time.

Persistent screaming—‘crying around the clock’.

Difficulty breathing.

Any abnormal discharge, especially from the ears.

A convulsion or fit.

Any strange posture or unusual eye or body movements.

A sudden outbreak of a strange rash you can’t identify.

Any unusual swelling or lump, especially if it is painful to touch.

Loss of interest in surroundings and/or abnormal sleepiness or


floppiness.

Thick, smelly urine.

Helping your doctor to help you


Find out about house calls and what service is available out of hours.

If several things are worrying you about your baby, make a list before you
see your doctor. Try to give her or him a clear message about the problem
without introducing a whole range of irrelevant issues. Ask for a clearer
explanation, if you don’t understand something.
Second opinions are useful, but if you keep shopping around no one will
be directly responsible for your care and you may not get the best help
when you really need it. Give your doctor time to get to know you and
your baby so she or he can give you individual care which is suited to your
needs.

Finally, babies and young children often behave in quite unpredictable


ways which are well within the normal range. They also get funny things
wrong with them when no one really knows what the matter is. Don’t push
your doctor for a diagnosis and medication for the sake of it. If she or he is
honest enough to admit they don’t know what’s wrong, respect this
honesty. Far too many normal babies and children are put through a
barrage of unnecessary and invasive diagnostic tests and given
inappropriate medicine because of pressure from parents for a precise
answer when there is none.

FURTHER READING
All About Kids’ Skin: The Essential Guide for Parents, Dr Phillip Artemi and Tina Aspres, ABC
Books, Australia 2008. Great detailed information by an Australian paediatric dermatologist and
a pharmacist.
11

Daily Care
Previous chapter | Contents | Next chapter
Unless you are used to handling small babies you are likely to feel
awkward and maybe nervous for the first few weeks when you dress and
undress your baby, change her nappy and bath her. Feeling like this is
normal. Your baby is blissfully unaware that you are learning and you will
be amazed how quickly you become efficient at babycare skills.

Changing the nappy


If you are using cloth nappies it really doesn’t matter which of the folding
methods you use as long as the nappy goes on firmly and does what it’s
supposed to do. The same size cloth nappies fit your baby until she no
longer needs them. Adjustments are made to allow for her size as she
grows by the way you fold the nappy. You will need to use double cloth
nappies at night once your baby starts sleeping longer. Most brands of
disposables last all night without leaking, but if there are problems try
poking holes in one nappy with a fork, put it on then put a second one over
the top.

How often?
Expect to use eight or more nappies every twenty-four hours. Nappies
need changing once or twice at most feed times and at other times when
your baby is awake.

There’s no need to change your baby before a feed when she’s ravenous
unless there’s a leaky mess. Likewise, if she’s been changed before and
during a feed it’s fine to put her down without changing her again. If your
breastfeeds are close and frequent don’t worry about changing her every
time you feed—just pop her on the breast and put your feet up.

What do you do?


Take off the used nappy using the front of the nappy to wipe off any poo
still on your baby. Fold the nappy so the poo can’t fall out and put it to one
side. Gently wash her bottom, front and back, with damp tissues or tissues
and pump pack sorbolene and glycerine, paying attention to wiping in
between creases. To clean the back part lift her legs, holding both ankles
together in one hand with a finger between her ankles and raise her bottom
slightly.

After washing, pat dry. Apply cream or powder if you are using any. Put
on a clean nappy. If you are using disposables, wipe your fingers clean of
any cream otherwise you’ll have trouble getting the adhesive tabs to stick.
The part of the disposable nappy with the tab goes to the back—the part of
the nappy the tab adheres to goes to the front.

Girls do not need the labia separated to ‘clean inside’. Boys should never
have their foreskin pushed back.

Dress your baby and leave her somewhere safe while you deal with the
used nappy. Whether you use a cloth or a disposable scrape the poo off the
nappy into the toilet before either soaking it or putting it in a plastic bag
and throwing it out. Don’t forget to wash your hands.

Dressing and undressing


Make sure the change table or bench top you are going to use to dress and
undress your baby is flat, firm, stable and the right height for you to work
comfortably. It’s much easier to use a change table or a bench top than to
use your lap or bend over a bed.

When dressing or undressing you’ll probably find it’s the top half that’s
the trickiest until you become more skilled.

Undressing
Leave the nappy till last. Undo all the fasteners. Gently slide her legs out
of the jumpsuit or pull off any tights. Roll the jumpsuit to shoulder level
and gently pull the sleeves over and off each arm. If your baby has a
separate top stretch the neck of the garment after your baby’s arms are free
and remove it carefully from front to back over her head so it doesn’t
touch her face.

Dressing
Put the nappy on first. Once again, stretch the neck of the garment and this
time, going from back to front pull it over her head so it doesn’t touch her
face, supporting the back of her head raising it slightly as you go. Guide
your baby’s arms through both arm holes into the arms then her legs into
the bottom half. Do up all the fasteners.

Dressing, undressing and bathing young babies is complicated by the way


a lot of them cry and appear to be very distressed while it’s all going on.
After the contained life in the womb where there were limits to their
movements and a relatively unchanging environment, even small changes
to their bodies and their world will worry them until they become
accustomed to new sensations and feelings. Lying naked on a bench top
must feel a bit like falling off a cliff to young babies as they have no
knowledge of the extent of their new boundaries.

By three months most babies don’t mind having their nappies changed and
love having a bath. Dressing and undressing is also much easier at this age.

If your baby cries a lot while you are attending to her care when she is
young, try to stay calm and do what you need to do. It’s a normal way for
babies to behave and doesn’t mean you are doing something wrong.
Individual babies’ responses to nappy changing, bathing, dressing and
undressing vary enormously. If your baby cries at these times and your
friend’s baby doesn’t, it doesn’t mean anything is amiss.

Here are a few tips to help:

Pick clothes that are easy to put on and take off. For example, front
fastening, pop fasteners, stretch or expandable fabric.

Avoid buttons and bows. Most families are given at least one
‘beautiful’ outfit which is invariably difficult to get a baby in and out
of, especially when the baby is in full crying flight. This doesn’t mean
you can’t ever use it, but save it for a special occasion.

Have three or four easy changes at the ready.

When dressing a crying, hungry baby, don’t worry about minor details.
Get the basics done, then do up buttons and straighten collars while
she’s feeding.
Sometimes young babies are calmer and easier to dress and undress
while lying on their tummy.

Bathtime
Hospitals usually give parents the opportunity to bath their baby before
going home so you know what to do. If you come home early or have a
home birth your midwife will show you at home.

Bathing grows into a happy time that becomes lots of fun for you both, but
in the early days you might wonder when the fun is going to begin! Lots of
new mothers find bathing difficult at first. When you get used to handling
a slippery baby and your baby starts to enjoy her bath, things improve
dramatically.

If you find bathing stressful during the first six weeks, only bath your baby
once or twice a week. ‘Topping and tailing’ (just cleaning her face and
bottom) are quite adequate the rest of the time.

On the other hand, if a deep relaxation bath helps a baby who cries a lot
then bathing twice a day is fine. It’s all right to bath your baby before a
feed, after a feed or in the middle of a feed. You will soon work out what
suits you both best.

There are many ways to bath babies. Here is one way.

First, a few safety reminders


Make sure the room is warm with no draughts.

If you use a sink, take care that your baby doesn’t bump against the taps
or burn herself on the hot tap.

Always put your hand on your baby before turning away.

Wrap her up and take her with you if the phone rings.

Put cold water in the bath first, then add the hot. Mix the water before
putting your baby in and test the temperature by dipping your elbow in.
The water should feel warm to the touch.

Prepare everything before you begin. You need nappies, nappy fasteners,
pins, singlet, jumpsuit or nightie, pilchers, cotton wool and soap or a liquid
baby bath preparation. Useful but not essential is a moisturiser, petroleum
jelly and your favourite nappy cream. You also need two towels or one
towel and a hand towel. Here we go!

Undress your baby. Leave her nappy on. Swaddle her snugly in a towel.
Wash her face with damp cotton wool or a flannel. Pat dry.

To clean her ears, smear a little petroleum jelly on a cotton wool ball,
shape it into a point then wipe firmly inside her ear, lifting out any
accumulated wax. Poking cotton buds into her ears or nose is dangerous
and never necessary.

Wet your baby’s head then soap it with soapy palms. Use a mild soap.
Tuck her under one arm, hold her head over the bath and rinse it well.
Babies usually enjoy this part. After her head is rinsed, lie her back on
the table and dry her head gently but briskly with your other towel.

Next, unwrap your baby and remove the nappy. Wet her body with your
hands and gently massage in some soapy water or a moisturiser. This is
when she is likely to cry. Gently turn her onto her tummy if it makes
things easier.

Now it’s time to put her into the bath—here’s how to pick her up. If
your hands are slippery or soapy rinse and dry them before you put
your baby in the bath. One hand supports her head, neck and shoulder.
The palm of your other hand supports both legs below the knees. Use
your forefingers to separate her ankles. Lift and gently place her in the
bath.

Once she is in the bath, keep supporting her head and neck. You will
find she will float in the water. Use your free hand to rinse off any soap
or just to gently splash water onto her body. Unless your baby has an
ear infection (unusual at this age) it doesn’t matter if her ears are under
the water when you bath her.
When you are ready, lift her out of the bath the same way you put her
in. Pat dry, especially behind the ears, between her fingers, under her
arms, under her chin and in the groin area. When she is dry, apply some
moisturiser if you want to.

Dress her. Remember, nappy first!

Another variation on the baby bath is the deep relaxation bath. The deep
relaxation bath can be used to help babies relax and sleep.

The water is deep and hot (38°C). You lift your baby into the deep bath
and hold her on her back in the water. Her head rests on your wrist while
your other hand supports her legs with your forefingers between her
ankles.

Move her backwards and forwards through the water. After a few glides
turn her over onto her tummy, supporting her head on the inside of your
wrist. Babies usually relax in the deep, warm water. Some fall asleep,
others kick and move about. It is easy to hold her as she is supported by
the water.

Keep baby in the water as long as it stays warm. When you lift her out,
leave her on her tummy. Place her on a dry towel and pat dry.

Like any practical procedure, bathing is difficult to do from written


instructions only. The deep relaxation bath is taught in maternity hospitals,
so if you are interested ask for a demonstration. If you miss out, ask your
friends who have babies how it is done.

If the deep relaxation bath bothers you, don’t feel pressured by well-
meaning advisers into feeling it is essential for your baby—it is an option
to use if you would like to. Babies also enjoy a shower with their mother
or father. A mat in the shower is essential to avoid falls.

Massage
After your baby’s bath, if you are both happy and relaxed, try some baby
massage. Baby massage is gentle touching using long, firm, smooth
strokes. Baby massage is beneficial at any age so wait until you feel
confident about handling your baby if you are a bit nervous during the first
six weeks. Baby massage is not for everyone, so don’t feel it’s something
you have to do if it’s not your scene. It is not the definitive answer to baby
crying and sleeping problems but it helps calm babies and it can be very
enjoyable for parents and baby alike. Baby massage is never very
successful when your baby is very tense and crying a lot or any time you
are rushed and feeling anxious or trying to keep an active toddler amused
as well. The best time is after a bath as long as she is not hungry. Like all
skills, baby massage takes time to learn.

First, wet and soap your baby’s head with your palms…

… then lift and gently place her in the bath.

A very simple method


Lie your baby on her tummy. Using a little baby oil or a mixture of
sorbolene and glycerine and water, rub your hands together. Stroke your
baby’s back using a hand-over-hand motion, gradually moving
downwards, stroking her buttocks and legs right down to her toes. Initially,
this is enough to start with, especially if turning her onto her back makes
her cry which is quite likely when she is very young. As time goes by and
you both become more relaxed, turn her over and continue stroking her
tummy and the front of her legs.

If you are interested in baby massage and wish to learn more, try one of
the many books or DVDs available which demonstrate this traditional art.

What to wear
Trying to work out what clothes to dress your baby in so she won’t be too
hot or too cold might cause you some concern. Try not to worry too much.
Once again, you’ll find as your baby grows you’ll quickly get used to
working out how much to put on or leave off.

Here is a reasonable guide


Summer: a cotton singlet; a cotton nightie or short-sleeve, short-leg
jumpsuit; sun hat if out of doors; nappy; socks; at bedtime, a cotton
cuddly and cotton mesh blanket if required.

Winter: one or two singlets or a bodysuit; a warm nightie or a long-


sleeve jumpsuit; a warm jacket or sweater; tights or socks, bonnet or
beanie if out of doors; at bedtime, one or two flannelette cuddlies and a
shawl and/or a blanket or quilt.

Obviously concessions have to be made for air conditioning and heating


(including in cars) and extremely hot or cold climates. As long as your
baby’s chest, tummy and head are warm to touch, she is comfortably
clothed. Hands and feet normally often feel cold so are not a good guide to
her body warmth. A good way to check is to put the back of your hand on
her tummy; a warm tummy means all is well.

An overheated baby goes very red in the face, sweats profusely and will
probably cry vigorously—although a certain amount of sweating and heat
rash is normal for all babies and not related to being overdressed.

Out and about


Facing the great outdoors can seem quite daunting in the early weeks after
birth and it’s easy to be overcome with dread at the thought of going
anywhere when you start to think of the effort involved. While you are
learning the best way to do the shopping, manage public transport and
keep appointments, life before baby suddenly seems very much easier.
Despite a few improvements in recent years our society is generally not at
all considerate to the needs of mothers trying to negotiate their way around
with little ones in tow. Many women tell me they start to understand for
the first time the problems disabled people experience in their daily lives,
especially those trying to get out with twins, triplets or a couple of babies
close in age.

You will find practice makes perfect and the more you go out the more
efficient you become at planning how to get where you are going and what
you need. Start with simple excursions and build up to more ambitious
ventures as you gain confidence. Having a baby bag always packed with
the basics makes outings easier. In your bag you need four or more
nappies, disposable wipes or damp flannels in plastic bags, cleaning lotion
and your favourite nappy cream, cotton balls, extra dummies (if you are
using a dummy), muslin squares for mopping up, plastic bags for laundry
and used nappies, safety pins, a pair of scissors and an all-purpose baby
blanket which can be used as a changing sheet, a cover or to put on the
floor so your baby can lie on something familiar and clean.

A lot of women are extremely nervous when they first start to drive with
their new baby in the restraint on the back seat of the car. Driving anxiety
passes so don’t let it put you off going somewhere in the car. If you are
worried because you can’t see your baby in the capsule attach a mirror to
the headrest on the back seat so you can keep an eye on her.

Breastfeeding while you’re out is often easy but sadly women


breastfeeding in public are sometimes still given a hard time. Wear a two-
piece outfit with a top that can be lifted from the waist. If the thought of
feeding in public bothers you, check about the availability of a feeding
room. If you are bottle feeding, the safest way to transport formula is to
take the cool, boiled water and the powdered formula in separate
containers and mix them when needed. If transporting prepared formula or
expressed breastmilk it must be icy cold when you leave home and carried
in a thermal baby bottle pack to keep it cold. If you cannot safely heat the
bottle when you reach your destination it’s quite all right to give it as it is.

Some mothers plan their outings around their babies’ eating and sleeping
schedules, others just go when they are ready. Either approach is fine.
There’s no need to go rushing out every day but you will find that you and
your baby are much happier at home and with each other if you spend
some time each week out and about.

Take care in the sun


The first and most important line of defence against the sun for all of us,
but particularly babies, is to avoid unnecessary sun exposure and cover up
as much as possible when in the sun. Babies in the first twelve months
should be kept out of direct sunlight. Most babies in Australia don’t need
daily sun kicks as they are exposed to enough indirect sunlight to get
adequate vitamin D. There are some exceptions to this—see the next page.
It’s fairly easy to keep young, immobile babies away from the sun by
providing light covering to exposed parts of their bodies. Use shades on
car windows rather than draping a sheet over the infant restraint, as it
interferes with efficient air circulation in the restraint. As your baby grows
it is vital to keep her covered when out of doors, ideally by a T-shirt with a
collar and a hat that provides shade over the face, neck and ears.

The second line of defence against the sun is the use of a suitable
sunscreen. As no sunscreen provides 100 per cent protection, babies and
toddlers should always be well covered by clothing, hats, shade and kept
out of the sun in the danger times (10 am–2 pm and 11 am–3 pm in
daylight saving time).

Sunscreen
There is no evidence that a small amount of sunscreen applied to exposed
parts of babies’ skin is harmful. Allergies to sunscreen are unusual. When
they occur it is more likely to be because of other ingredients in the
product rather than the sunscreen base. Always do a skin test by applying a
small amount on your baby’s forearm—if there is no itch or sting the
product is safe to use. If there is a negative reaction, try another product.

Some sunscreen now contains insect repellent (Deet). Avoid using this
preparation on babies and toddlers as they may ingest it.

The sunscreen you use should be broad spectrum and water resistant and
have a sun protection factor of 30. Specially formulated baby and toddler
sunscreens are thought to be less allergenic and so less likely to irritate a
baby’s skin. Use the sunscreen according to the manufacturer’s
instructions and do not use in place of appropriate clothing and hats.
Sunglasses are now advised as well. Older babies often pull off hats and
sunglasses, but persist—as they get older they can’t remember what it is
like to be without them. Be a role model and always wear a hat and
sunglasses yourself.

Vitamin D deficiency
Vitamin D is essential for the absorption of calcium. Deficiency of vitamin
D prevents adequate mineralisation and calcification of bone and results in
rickets (soft, weakened bones). Vitamin D is found in small quantities in
cod liver oil and fatty fish, however most Australians get their vitamin D
from sunlight. Recently there have been a small but increasing number of
women and babies diagnosed with bone problems due to vitamin D
deficiency. Those at risk include women with dark pigmented skin, those
who have reduced sun exposure for cultural reasons (including veiling)
and those with an inadequate dietary intake of calcium and vitamin D. So,
while we need to be vigilant about avoiding sun damage, a small amount
of safe sun exposure on bare skin without sunscreen is advised for those at
risk of vitamin D deficiency.

Care in hot weather


Healthy babies do not suddenly dehydrate when the weather gets hot
(think of all the babies around the world who live in very hot climates) as
long as a little care and commonsense is used. The fontanelle on all babies’
heads pulsates, so there are times when it looks depressed or ‘sunken’—
this is normal.

Hot weather tips


Keep your baby out of the sun during the dangerous hours. The sun’s
ultraviolet light is at its most intense between the hours of 10 am and 2
pm (11 am and 3 pm in areas where there is daylight saving).

Dress your baby in light, cool clothing—when out of the sun a singlet
and nappy is all she needs. Use cotton cuddlies for wrapping.

Never leave your baby in a parked car.

Use a fan (not directly on your baby) in the room where your baby
sleeps (unless of course you have air conditioning).

Well-fed, healthy babies (breastfed or bottle fed) do not need to be


constantly offered extra water in hot weather. If it is very hot and you
think your baby is thirsty, by all means offer some water, but don’t get
worried if she doesn’t drink it. If you are breastfeeding offer extra feeds
—there’s plenty of water in breastmilk.

Where should she sleep?


What was once a relatively simple matter of personal choice ‘where baby
sleeps’ has become complicated by the growing evidence that in terms of
the relative risk of Sudden Infant Death in Infancy (SUDI) the safest
option is to sleep baby in a separate bed in the same room as the parents
for at least the first six months.

I have always believed in giving parents safe options whenever possible


and in the past have described the advantages and disadvantages of the
three baby sleep options (baby in a separate bed in the same room as
parents; baby in bed with parents; baby in separate bed in a separate room
to parents) and left it up to parents to work out where they sleep their
babies albeit with the proviso that if co-sleeping it is vital to follow the
specific recommendations from Sids and Kids to ensure optimum baby
safety.

I have also included bed-sharing as an option for unsettled babies in the


first six months, which in light of recent findings (see chapter 6) must now
come with a warning that sharing sleep surfaces (beds, lounges, couches,
rocking chairs) entails a greater risk of fatal sleep accidents and SUDI than
if babies are put to sleep in their own safe sleeping space.

What you need to know about safe sleeping

Sudden Unexpected Death in Infancy (SUDI)


The term SUDI is an umbrella term covering all sudden and unexpected
deaths of babies. Some sudden unexpected deaths in babies are the result
of serious illnesses or particular problems some babies are born with
which, sadly, are mostly unpreventable. However, most unexpected infant
deaths are caused by Sudden Infant Death Syndrome (SIDS) or Fatal Sleep
Accidents.

Sudden Infant Death Syndrome (SIDS)


When no cause for the death can be found by history or autopsy it is called
SIDS. It is still not known what causes SIDS but owing to the Reducing
the Risk program in place since 1991, SIDS deaths have dropped by 85 per
cent. SIDS deaths account for about 140 deaths a year. More boys than
girls die of SIDS, more babies die in winter than summer. As asphyxia (a
known cause) can never be ruled out because it is difficult to determine
asphyxia on autopsy, there is a reasonable possibility that some SIDS
deaths are, in fact, deaths caused by fatal sleep accidents.

Fatal Sleep Accidents


Known causes for fatal sleep accidents include: suffocation by a soft
pillow; strangulation by a long dummy cord; asphyxia from getting caught
under adult bedding; getting trapped between a wall and a bed; falling off
a bed; being rolled on by an adult in a deep sleep; overheating from too
many coverings, a hot water bottle or an electric blanket.
Reducing the risks
Most sudden unexpected deaths in infancy are preventable by removing
known risk factors and providing a safe sleeping environment. Ninety-five
per cent of deaths from SUDI have occurred by six to eight months of age.
The following are recommendations to reduce the risk factors of sudden
unexpected deaths in infancy:

1. Put your baby on her back to sleep from birth

The risk of SUDI is increased if babies are put to sleep on their sides or
tummies. Concerns about increased risks of babies inhaling and
choking on regurgitated milk when sleeping on their backs has been
shown to be unfounded. Back-sleeping babies are less likely to choke
on regurgitated milk than tummy-sleeping babies.

From five or six months onwards many babies roll all over the cot at
night and sometimes end up on their tummies. Most SUDI deaths occur
under this age so you do not have to try to keep them off their tummies
at this time. Put your baby on her back to sleep and let her find her own
sleeping position. Follow all the other recommendations for safe
sleeping: make sure the mattress is firm and fits securely with no gap
between the mattress and the sides of the cot; that there are no dangling
blinds, curtains, cords or mobiles within your baby’s reach; that there is
no bumper, pillows or anything else in her cot that could cover her face.
If you use blankets rather than a sleeping bag make sure her feet are
touching the bottom of the cot and she is well tucked in under her arms.
Sleeping suits with a fitted neck, sleeves and legs are great for babies
once they start rolling around as they keep them warm without blankets
and allow them to move safely.

It is not necessary at any age to buy a device to keep your baby on her
back. One of the problems that inevitably arises out of any
recommendations made in relation to SUDI is that there also be
corresponding commercial attempts to use these recommendations to
sell baby products to anxious parents. There is no scientific evidence
that has convinced Sids and Kids that any specific babycare product
reduces the risk of SUDI.

2. Sleep baby with face uncovered


Make sure your baby’s head remains uncovered during sleep by putting
her feet at the bottom of the bassinet or cot so she can’t slip down under
the covers. Do not use bumpers, quilts, doonas or pillows in the cot.
Tuck her in securely so the bedding is not loose, alternatively use a safe
sleeping bag with a fitted neck and armholes.

3. Keep your baby in a smoke-free environment

Cigarette smoke harms babies inside and outside the womb. If the
mother smokes, the risks of SIDS doubles, if the father smokes as well
it doubles again. The risks increase if the baby sleeps with a parent who
is a smoker. For reasons that are unclear, the risk of SIDS is increased
even if parents smoke outside away from the baby.

Giving up smoking is not easy but it’s worth the effort in terms of your
own health and the health of your baby. Call the Quitline on 13 78 48
for help.

4. Provide a safe sleeping environment

Sleep your baby in a cot next to your bed for the first six to twelve
months

There is growing evidence that this is protective against SIDS and fatal
sleep accidents.

5. Breastfeed your baby if you can.

The evidence to support the protective benefits of breastfeeding is


strong enough to warrant it being returned to the list of
recommendations for safe sleeping.

Most women do not ‘choose’ formula. Breastfeeding is nearly always


abandoned because of insurmountable problems and/or lack of support.
If your breastfeeding falls apart take comfort in the fact that the other
five recommendations are all eminently achievable and will provide
strong protection for your baby from SUDI.

Where to sleep baby—a discussion


In the first six months there is enough existing evidence to show that the
safest place for babies to sleep is in their own beds in their parent’s room.
Until more definitive research is undertaken on the risk of infant death and
co-sleeping, the safest approach is one of conservative risk management
and as a responsible health professional it is impossible for me to ignore
this.

If you are a committed co-sleeping parent I urge you to go here and


download Coroner John Olle’s findings (on the right hand side under
‘Related Rulings’) and carefully read the discussion papers before making
your decision.

Coroner Olle has come in for a great deal of criticism from promoters and
supporters of breastfeeding and others who believe that ‘co-sleeping’,
‘sharing sleep’ is essential for successful breastfeeding and optimum infant
social and emotional welfare. I believe, judging by comments on the web
and reported in the media, that very few of the people criticising his
concerns about co-sleeping have read what he has to say and the
compelling evidence his strong and humane advice is based on.

Why the reluctance to heed Coroner Olle’s and researchers’


recommendations?
Because the numbers of infant deaths from SUDI are statistically small
there are always going to be relatively large numbers of parents who can
claim that ‘they slept with their babies and it was fine.’ Parents of past
generations can make similar assertions in relation to sleeping babies on
their tummies, transporting babies in cars without restraints, drinking
alcohol and smoking during pregnancy, allowing kids to ride bikes and
scooters without helmets and so on but the fact that babies and children are
resilient (and lucky), is not evidence that certain practices are okay. Even
if the statistics for deaths of healthy babies are small the unexpected death
of a baby, with or without any apparent cause, is devastating for the
parents and family.

I am only too aware that the emphasis today on various aspects of child
safety has the capacity to drive parents batty. In many ways it also
encourages us to wrap kids in cotton wool and limit their risk-taking to
unacceptable levels nevertheless it is foolish to ignore the concrete
evidence child safety recommendations are based on especially when, in
the case of co-sleeping, the recommendation involves a relatively simple
measure, which doesn’t involve great inconvenience, for a short time in
the whole of a baby’s life. While the existing evidence supports this
measure there is no evidence (but plenty of opinion) supporting the
popular notion that healthy babies in loving homes have long-term
advantages/disadvantages based solely on whether they slept in their
parents beds or slept alone. Co-sleeping may be helpful for some women’s
breastfeeding but it is not essential for successful breastfeeding.

I realise that it is up to parents to decide where they will sleep their babies
in the first six months—there are no ‘laws’ involved here—and for a
variety of reasons some will still choose to co-sleep and some will—as
many parents did in other eras—choose to put their babies in their own
rooms. Bearing this in mind I will include these alternatives with
information about the small but greater risks of SUDI both these choices
involve.

The three baby sleeping options

1. Separate bed—sharing your room

You can have the bassinet or cot right near you so you can touch and pat
your baby without getting up. Some parents have a three-sided cot
arrangement attached to the bed at the same level so the mother has her
own space but is still in contact with her baby.

Advantages
According to the latest analysis of the research, this is the safest option
in relation to SUDI.

Disadvantages
If you are among the unfortunate parents who find they can’t sleep even
when their baby is sleeping because of the noisy breathing, grunting,
sucking of fists, hiccoughing, farting and wriggling, all I can suggest is
that you will get used to it. I do sympathise as I found it very hard to
sleep when my babies were in the room.
2. Sharing your bed (or, more technically, sharing a ‘sleep
surface’)

Bed-sharing, co-sleeping, sharing a sleep surface has run the gamut over
the decades. The practice was frowned upon for much of last century for
weird reasons that seemed to be mostly related to discipline, spoiling and
turning baby into a little tyrant although, on consideration, safety was
probably an issue as well. In the late eighties and nineties the pendulum
swung in the opposite direction when it was assumed that it was super-safe
and that all parents secretly longed to sleep with their babies but were
being discouraged by bossy health professionals for no good reason. Since
then co-sleeping has been vigorously promoted in some quarters as not
only being super-safe but as a strategy lowering the risk of SIDS. As
discussed current evidence disputes this claim.

As well, many adherents of co-sleeping make over-inflated claims that the


family bed is a crucial feature of committed parenting ensuring optimum
outcomes in terms of child emotional and social development. As
previously mentioned, while sharing sleep surfaces can be very pleasant
for those for whom it suits, there is no long-term research to support these
claims.

Is it safe?

There is an increased risk of SUDI for all co-sleeping babies in the first six
months, less clearly the second six months. That risk is higher in the
following circumstances:

When babies are less than four months of age, when babies are born
prematurely and when babies are born small for their gestational ages.

Falling asleep with babies on lounges or sofas (or leaving babies to


sleep alone on adult beds, sofas/couches/lounges) brings increased risks
of SUDI.

Sharing sleep surfaces with babies should be ruled out when:

Babies share sleep surfaces with smokers.

There is adult bedding, quilts, doonas or pillows that may cover


babies.
Parents are drunk, drugged, overly tired or very obese.

There are pets in the bed.

The surface is a waterbed, beanbag or a sagging mattress.

If you decide to co-sleep it is crucial to make sure that:

The mattress is firm with a tight-fitting sheet.

Your baby is not close to the edge of the bed where she might fall—the
safest arrangement is an adult mattress on the floor.

Your baby is placed her on her back at the side of one parent—not
between parents as this increases the risk of her slipping under covers.
The ideal way is facing your baby with your body in a position which
stops your baby from going under the sheets or into the pillow. A
sleeping bag with a fitted neck and armholes will keep her warm
without the need for blankets/sheets.

Your baby’s head stays uncovered.

Your partner knows the baby is in the bed.

Your co-sleeping is a planned strategy. Occasional haphazard


arrangements in a daze in the middle of the night usually mean that safe
sleeping recommendations go by the board.

Advantages
Later, when babies and toddlers are older (and it’s safe to co-sleep), you
may prefer bed-sharing to other strategies, for example the dreaded
‘controlled-crying’. I must add here that many parents end up neither
sharing sleep or doing ‘controlled crying’—lots of babies and toddlers
sleep well in their own cots from a young age.

For those whom it suits the closeness and convenience of co-sleeping is


special and for some parents co-sleeping is an important part of their
child-raising philosophy. In the past I have never attempted to dissuade
parents keen on co-sleeping and even now my objection to it in the first
six months is based solely on safety.

Disadvantages
Despite the promotion of bed-sharing as a good thing over the last few
decades many parents in our society are not bursting to sleep with their
babies and toddlers because sharing the bed involves a degree of
discomfort and irritation they find intolerable. This does not mean they
are not ‘attached’ parents.

You might find you can’t relax and sleep for fear of rolling on your
baby particularly in light of current evidence and recommendations.

Not all crying, unsettled babies automatically sleep better once they are
in their parents’ bed. Some continue crying anyway—if your baby is
like this it might be easier to settle her in her own bed.

You’ll find the bed-sharing goes on indefinitely unless your baby sleeps
mostly in another bed by three to six months of age. The bed-sharing
arrangement is rarely voluntarily ended by the child until she is three to
five years old. Deciding to change the arrangement before your baby or
child is ready involves strategies that a lot of parents find painful. There
is usually not an easy answer so if you think sharing your bed with your
baby is going to worry you in the future, try not to let it go much past
three months.

3. Own bed, separate room

If you secretly think you’d really like to have your baby in another room
sometime in the first six months and definitely in the second six months
when many babies call and wave and screech their way through the night
because they know you are so close, you are not a monster parent. Many
parents feel exactly the same way; however, there is higher risk of SUDI in
the first six months when babies are in separate rooms than when they are
in separate beds in the same rooms as their parents. This is possibly
because in the latter parents can see their babies and check to see that they
are safe.
This protective effect doesn’t work if the baby shares a room with
children. (I wonder how parents get out of bed at all there’s so much to
worry about.) So, unfortunately, after weighing it all up I can’t give the
blessing for separate rooms either—in the first six months at least. Baby
monitors are not the answer because there is no evidence that they protect
against SUDI in any way.

Where to sleep baby—a summary


The all-embracing term Sudden Unexpected Death in Infancy (SUDI) is
now used to cover all sudden and unexpected deaths in infancy due to
medical problems, Sudden Infant Death Syndrome (SIDS) and fatal
sleep accidents.

According to the best information available at the moment, the safest


way to sleep babies is in their own cot near the parents’ bed for the
first six to twelve months. This may change but until we know more
this is what I recommend.

Swaddling or wrapping
Swaddling or wrapping babies is a method which has been used by many
cultures for centuries to help babies sleep. It makes them feel secure and
prevents them from waking themselves up with their startle reflex.
Swaddling doesn’t suit all babies and as there is no ‘medical’ reason to
swaddle healthy, full-term babies; if your baby doesn’t like being wrapped
and it doesn’t help her to sleep, forget about it.

Lotions and creams


A guide to the basic lotions and creams you may need in the first three
months follows:

Heads
Wash with simple soap

To soften cradle cap crusts:

Vaseline, oil

2% Acid Sal/2% Sulphur in sorbolene

Apply overnight—wash out the next day

Crusty eyebrows:

Apply a little sorbolene and glycerine to eyebrows

Crusts behind ears:

Apply a little sorbolene and glycerine at each nappy change

Heat rash and hormone rash:

Do not treat

Bodies
Options in the bath:

Nothing

Baby lotion

Moisturiser options:

Moistened sorbolene and glycerine

Red skin between skin surfaces e.g. back of elbow joint, under chin, back
of knee join, under arms, groin area:
Zinc and starch powder

OR

Cornflour

Sunscreens

See ‘Take care in the sun’.

Heat rash

No need to treat under three months

Bottoms
Options for cleaning

Damp tissues

Commercial nappy cleaning lotion*

Disposable wash cloths*

*avoid using if rash present

Soothing barrier healing creams

A variety are available—e.g. Desitin, Amolin, Ungvita, Paw-paw cream


etc. Select one and apply every nappy change

Red anus and/or a red genital area (including bottom)

Choose from:

Desitin

Penatin (anus & genitals)

Amolin (anus & genitals)

Bepanthen (genitals)
Fungal infection

(diagnosis required)

Topical anti-fungal

Heat rash under nappy that doesn’t clear spontaneously

Zinc and starch powder

OR

Cornflour

The number of creams and lotions available for babies’ bottoms, heads and
bodies is overwhelming. Skin peculiarities in the first three months tend to
be transitory and generally do not need much treatment.

A word about sorbolene and glycerine. Combined sorbolene and glycerine


is an inexpensive moisturiser which is great for babies’ skin and has a
number of uses. It comes as a thick preparation in tubs of various sizes or
as a thinner preparation in pump packs. Pump-pack sorbolene is ideal for
cleaning the nappy area or using over your baby’s body. The thicker
variety is good for small areas, such as dry skin patches, behind ears and
for cradle cap (see chapter 10). Don’t put sorbolene and glycerine on heat
rash and hormone rash as it increases sweating and makes the rash worse,
especially on the face. Sometimes too, sorbolene and glycerine stings
when it is applied to a raw area, for example a bright red, weeping bottom.

FOR MORE INFORMATION


Chapter 12: Safety (for safe use of change tables; nappy buckets)

Chapter 13: Growth and Development (the startle reflex, the Moro reflex)

Chapter 14: Sleeping and Waking in the First Six Months (options for settling)

Chapter 16: For Parents (sudden infant death syndrome)


12

Safety
Previous chapter | Contents | Next chapter
A higher standard of living, improved preventable health care, better
health education and major advances in medical technology have all
helped reduce the baby and child mortality rate over the past century.

It is sad to note, however, that while the preventable causes of death and
disability have largely been eliminated our young are still at risk from
preventable injuries. Injury is the leading cause of death for children under
fifteen years. The cost in cash terms to the community is estimated several
million dollars a year. The cost in anguish, pain and disability can never be
measured.

Why do such accidents keep happening to our little ones? It’s not because
child safety is ignored. Excellent child-safety information is available in
books via the media and as part of parent education programs. Major
children’s hospitals throughout Australia have enthusiastic, knowledge
able staff available for advice and education. Laws are passed in the
interest of child safety—for example, the mandatory use of child restraints
in cars and bicycle helmets.

It’s not because parents don’t care. Wanting to keep our babies safe
forever is a very strong instinct so it’s hard to understand why so many
children die or need medical attention as a result of unintentional injury.

The greatest number of deaths and injuries occur in the one-to-four age
group and are caused by motor vehicle/pedestrian accidents, drowning (the
most common), choking, suffocation, falls, burns and scalds, poisoning
and electrocution.

As well as these specific causes, accidents happen for two important


general reasons. People believe accidents to be ‘fate’ or something that
happens to someone else. Many parents take it for granted that they will
know how to protect and care for their babies and children. In fact, child
safety depends a lot on acquiring knowledge, recognising potential
hazards, planning ahead and budgeting for safety items as they are needed.
Very few adults understand or appreciate baby and child development
before they have their own babies. Unless an effort is made to learn about
development, parents are not always aware of the potential hazards their
babies and children face living in an environment primarily designed for
adult comfort rather than child safety.
Babies and children develop dramatically from birth to age five. Children
aged between one and five years are at greatest risk of injury and home is
the place where they are most likely to come to harm.

Babies in their first year are also vulnerable and need your protection, so
it’s worth taking a little time to plan a safe environment for your baby
before the birth. As well, learn all you can about baby development as you
go so it’s easier to understand the things babies do at various ages that are
likely to lead to unintentional injuries.

Specific hazards relating to development and ways of avoiding injuries are


looked at in each section of this book. This section gives you a general
guide to making your home safe as well as looking at the special safety
needs of babies in the first three months.

The risk of injury is increased when


Either parent is unwell but especially when the mother is unwell;

The baby cries excessively or the toddler is extremely active and never
sleeps;

There’s great excitement caused by visitors, a new baby, and so on;

There’s a change of environment such as holidays, moving house or


visiting;

There’s nowhere safe for the baby to play;

The baby equipment doesn’t comply to safety standards;

The baby equipment is damaged or not in working order;

The parents have unrealistic expectations of baby behaviour and no


understanding of normal baby development.

Making your home safe


Once your baby arrives you have much less time for housework, repairs
and shopping. The excitement, tiredness and stress can also make you
more vulnerable to injuries during the early months so it’s a good idea to
think about repairs and changes before your baby arrives.

Heart–lung resuscitation
It’s an excellent idea to be prepared for emergencies. Think seriously
about doing a heart–lung resuscitation course before your baby arrives. If
this is not possible, try to set something up after the birth when you are
over the initial adjustments. Courses are available in your state from the
Royal Lifesaving Society, the Red Cross and St John Ambulance. Single-
page charts of basic resuscitation techniques are available from children’s
hospitals in all states. Pin one on to the back of the toilet door where you
will have a constant reminder of what to do.

Kitchen
Replace electrical appliances and cords if they are old or if you doubt
their quality. Short or curly cords are much safer than old dangly cords.
If buying a new kettle consider a cordless one.

Make sure you have plenty of hand towels for quick drying of wet
hands before using electrical appliances. A good supply of insulated
mittens and pot holders makes handling hot dishes and pots safer.

Do you know what to do if a pan catches fire on the stove?

Smother the fire with a damp cloth or lid; and

Turn off the hot plate or gas.

Never
Throw water over the flame.

Attempt to remove the pot.

Always keep a close eye on boiling fat or oil and never leave the
kitchen while using boiling fat or oil.
Overloading electrical sockets is dangerous. Lighting and appliance
switches should be located well away from taps.

A non-slip floor is always advisable, but especially in the kitchen. It’s a


good idea to get into the habit of wiping up spills immediately.

Replace tablecloths with placemats.

Always turn the handles of your pots and pans inwards. Get into the
habit of using the rear hot plates or burners before the front ones.

Make sure your stove is anchored to the wall or floor, and fit a stove
guard.

Install protectors on easy-to-reach stove knobs.

A lid on your kitchen bin helps prevent disease and, after your baby
becomes active, helps prevent exploratory ventures into the rubbish and
the possibility of her inhaling something.

Keep knives and sharp tools out of reach—the same for matches and
lighters. Plastic bags are a great hazard for babies and children so store
them well out of reach too.

Keep all detergents, bleaches, dishwashing detergent and household


cleaners locked up. If they are normally kept in a cupboard under the
sink install a child-resistant latch on the cupboard door or store in a
high cupboard inaccessible to children.

A dishwasher with a safety lock is strongly recommended.

Bathroom
The hot and cold taps should be clearly marked. Use a tap protector to
inhibit children turning on the hot water tap.

Never use electrical appliances or heaters near the bath or shower.


Electrical heaters should be installed high on the wall. Store and use all
electrical appliances in a room other than the bathroom.
Use a non-slip mat on the bathroom floor.

Use a non-slip mat or decals in the bath.

Install a child-resistant cabinet for medicines, aerosols, hair products


and so on.

Remember to keep the toilet lid closed. Bathroom cabinets installed


above the toilet are hazardous—toddlers love to climb onto toilet seats
and open bathroom cabinets.

Nappy buckets are a potential disaster because mobile babies pull


themselves up on them, tumble in and drown, so if possible keep them
in the laundry or somewhere out of reach in the bathroom.

Store scissors, razor blades and any other sharp objects out of reach.

Being able to open the bathroom door from the outside means no one
gets locked in. Installing a privacy lock-set is a way of keeping privacy
while maintaining access in case of an emergency. Alternatively, install
a safety device that inhibits children turning the knob.

If using a baby bath aid, check that it meets the Australian Standard and
that your baby fits properly in the aid. Baby bath aids are for parent
convenience, they are not safety devices.

Laundry
As in the kitchen, keep all cleansing agents, chemicals and dangerous
equipment in cupboards with child-resistant latches or store in a high
cupboard inaccessible to children.

Keep the washing machine and tumble-dryer closed at all times; again
child-resistant latches are a good idea.

A childproof lock on the laundry door ensures unsupervised babies or


children stay out.

Bedrooms
Your baby’s room
Check cots, bassinets and change tables are safe and stable. Don’t place
cots, bassinets or change tables near windows with dangers such as
hanging venetian blind cords or curtain ties—these are dangerous.

Install bars and safety locks on bedroom windows to ensure that


windows do not open more than 100mm (4 inches). This will stop little
ones falling out. Leave the area around the windows free of furniture.

Low-power night-lights in your room, the baby’s room and the hall
makes it safer when you attend to your baby at night.

A child-resistant lock or handle to your room and/or the baby’s room


will prevent smaller children making unsupervised visits to the baby.

Use child-resistant power point plugs.

Your room
Store medications, perfumes, make-up, scissors, earrings, pins, cuff
links, coins or breakables away in a safe place.

Safety catches are simple to install on the window in your bedroom.


Don’t put anything near your window that a toddler can climb onto.

Halls, living room and stairs


Keep all doors, passages and stairs free of obstructions.

Arrange storage for vacuum cleaners and any other major electrical
appliances.

Use child-resistant power point plugs on all power points.

Avoid slippery floor coverings, loose rugs or highly polished surfaces.


Use non-slip underlay to hold mats and rugs in place.

Special fireguards should be used in front of all fires. The guard should
be firmly fixed to the floor or wall.

Consider installing safety glass if you have large areas of low-level


glass. Alternatively, apply glass safety film. Glass doors should be
made more obvious by attaching a colourful motif to them at child and
adult eye level.

Remove small, fragile or breakable items until your youngest child is


about five years old.

Precious possessions, musical equipment, televisions and DVD players


should be kept as high as possible. Store CDs and DVDs well out of
reach.

Alcohol is a poison for a child. Store alcohol and cigarettes well out of
reach.

Indoor plants should be non-poisonous and you might find it easier


keeping indoor plants outside until your baby is past the eating dirt
stage. Plants with berries can be choking hazards.

Loop curtain and blind cords out of reach as they are strangulation
hazards. Alternatively, shorten cords so that they are more than
1500mm above the floor.

Install safety barriers at the top and bottom of the stairs.

Pets
Pets who are used to a free run of the house need re-educating. If you can
change their habits before the birth you will avoid potential hassles.
Always supervise children around animals and household. Show children
how to behave towards animals.

Treating your home for pest control


Find out the chemicals being used and check by calling 13 11 26, which
will connect you to a Poisons Information Centre in your state. If
appropriate select a low or non-toxic product. If possible, arrange to be out
of the house when the treatment is being done and to allow some time for
airing before being inside again. Always ask if there will be anything left
behind (pellets, etc.) and where they are going to be left. Mosquito zappers
and coils are safe to use in your baby’s room. Care needs to be taken to
make sure they are out of reach of older babies and toddlers.

For overall house safety


Install a smoke detector and regularly check that the detector is
working;

Lower the hot water temperature to 50°C;

Install a safety switch or a mains-operated circuit breaker.

Babies aged between birth and three months are not very mobile, but you
need to be aware of certain safety measures for even this young age group.

‘When eyes are off, hands should be on’ is a vital safety rule. It’s amazing
how quickly babies wriggle off change tables, slip under water or roll off a
bed.

When using a change table, make sure


It is stable and will not collapse while you are using it;

The sides are raised so your baby can’t roll off;

It’s the right height for you to work comfortably;

The changing surface is strong, easy to clean and there are no gaps or
spaces near the changing surface that your baby’s head or limbs can get
caught in;

You never leave her unattended on the change table. A strap to keep
your baby in place is useful but she still shouldn’t be left unattended
even when secured with a strap;

Everything you need is within reach.


Bottle and dummy safety
Bottles shouldn’t be propped and left. If something needs your attention
in the middle of a feed ask for help or, if it’s not urgent, delay what
needs doing until after the feed. If you have to answer the phone or
front door take the bottle with you.

When buying a dummy, go for a good quality brand rather than a cheap
one. Look for a brand approved by the Australian Standards.

Resist the temptation to dip the dummy in gripe water or honey. There
are potential risks of botulism poisoning from giving babies honey in
their first year and gripe water is sweet so encourages a habit which
may be difficult to break. Dummies dipped in sweet things eventually
lead to black teeth.

Never use anything, for example a rolled-up nappy, to hold your baby’s
dummy in place as she is unable to spit out the dummy if she has
trouble breathing and may suffocate.

Attaching the dummy to your baby’s clothes with ribbon or string is a


strangulation hazard. You also risk cutting off the blood circulation to
her finger or hand if the ribbon or string gets wrapped around her finger
or wrist.

Keep dummies clean by giving them a good scrub then boiling or


steaming for a couple of minutes or leaving them in a disinfecting
solution.

Inspect your baby’s dummy regularly and replace it when necessary.

Adults should not suck dummies before placing them into their baby’s
mouth. It does not clean the dummy. Sucking the dummy, in fact, is a
potentially dangerous practice that can introduce a range of bacteria
into the baby’s mouth and gut that can cause health problems.

For more on bottle and dummy safety, see chapter 5 and chapter 7.

Portable chairs
Make sure the baby chair has a broad base so your baby can’t push back
and topple over.

Always secure your baby with the harness—the best harness is one that
covers shoulders, waist and crotch.

Baby chairs can move off a table top amazingly fast propelled by
nothing more than a baby’s gentle movements, so the floor is the best
place—don’t forget to remind everyone the baby is there! Keep a close
eye on other children, pets and adults carrying hot drinks or food.

Cots and bassinets


Buy a Standards Australia-approved cot.

Place the cot or bassinet away from windows, heaters and power points.

Always remember to keep the cot sides up.

Never use hot water bottles or electric blankets for babies or toddlers.

Remember to take your baby’s bib off before you put her to bed.

Remove plastic coverings from mattresses and dispose of immediately


—don’t use them to protect the mattress. Any plastic is dangerous—
keep all kinds of plastic bags and film away from babies.

Do not use bumpers, pillows or put toys in the bassinet or cot.

Strollers and prams


Buy a Standards Australia-approved stroller/pram.

Make sure the brakes work properly. Test without the baby inside.
When you buy, check that the safety harness has both shoulder, waist
and crotch straps and that they can be adjusted to be used effectively,
even when your baby is very young. Babies falling from strollers and
buggies is a very common occurrence and it is often because safety
harnesses are inadequate.
Don’t overload the stroller or pram when your baby is in it. Try to avoid
hanging shopping bags from the handles.

Always fit and adjust the safety harness correctly.

Ensure the tether strap is secured to your wrist when using the pram or
stroller.

When you change the position of the pram or stroller, make sure your
baby’s hands or fingers can’t get caught.

Avoid using the pram or stroller on escalators. Whenever possible take


the lift.

Car safety
For details on the purchase, legal requirements and safe use of infant
restraints please see Choosing Baby Products, chapter 5.

Other general safety tips


Avoid nursing your baby and drinking a hot drink at the same time. Ask
friends to put their hot drinks somewhere safe when they nurse your
baby.

Smoking and nursing a baby is also a health and safety hazard. Give up
smoking or if you can’t, don’t smoke or allow others to smoke near the
baby.

Powder is useful for some skin conditions. When using powder put a
small amount into a saucer then apply with your fingertips. Don’t shake
the powder vigorously into the air—your baby might inhale some.

Cotton buds need never be used. Cotton wool balls are quite adequate
for noses, ears and bottoms.

Check clothing, especially bootees and socks, for loose threads that
might cut off circulation or strangle your baby.

Select nightwear that meets the Australian Standard.

If you give your baby medication check what it does, what’s in it,
possible side effects and the correct dose. Always read the label. If you
have any doubts, don’t give it.

Toy safety
All rattles, shakers and stuffed animals or dolls should be free of small
parts that could be chewed or pulled off and swallowed.

There should be no sharp edges or harmful ingredients.

Choose toys appropriate for your baby’s age. Toys for toddlers may be
dangerous for babies. Check labels, especially when your baby receives
a toy as a gift.

Throw away broken or grubby toys well past their ‘use by’ date.

Take care with the packaging. Babies often enjoy the packaging as
much as the toy so throw away any plastic and check the box for sharp
bits or staples.

When buying toys look for those that meet the specification of the
Australian Standard.

Avoid toys that use button batteries to power them.

Babysitter safety
It may be some time before you feel you can leave your baby and
obviously you will feel much more comfortable if you can leave her with a
grandparent, family member or a trusted friend when you do take the
plunge. If you use an agency, make sure it is one recommended to you by
someone whose advice you respect. Inexperienced teenagers are not the
ideal babysitters for young babies.
Show the babysitter how to use equipment such as the stove, heaters
and so on.

Make sure she knows where your emergency list of phone numbers is
(see below).

Always leave your phone number and address and the phone number of
a reliable friend or relative in case she can’t locate you.

Your babysitter also needs to know, in writing, what to do in an


emergency and where the first-aid kit is kept (see below).

Leave your babysitter a reliable torch.

Emergency numbers
Have a list of important numbers near the landline and in your mobile:

Police

Poisons Information Centre

Ambulance

Fire Department

County Council

Nearest Children’s Hospital

Family Doctor

Child and Family Health Nurse

Neighbour

Relative

Chemist
Your first-aid kit
Dressings
Crepe bandages in various sizes

Gauze squares for cleaning wounds

Non-stick squares that won’t stick to wounds and cause bleeding and
pain when removed

Adhesive tape

Triangular bandages to use for slings

Cotton wool swabs

Sticking plaster

Clean, non-fluffy cloth or clean plastic film to cover burns until seen by
a doctor

Creams, lotions, antiseptic


Antiseptic solution

Calamine lotion

Saline eye wash for foreign bodies in the eye

Spray for treating stings

30+ sunblock cream

Paracetamol tablets and liquid with child restraint lids

First-aid equipment
Safety pins of various sizes
Scissors with one sharp end and one blunt end

Tweezers

Disposable gloves

Immunisation
Immunisation is safe, simple and effective and has saved the lives of
millions of adults and children worldwide. High levels of childhood
immunisation in a community protect not only the children who are
immunised but those vulnerable others who are too young to be
vaccinated, the rare baby who can’t be vaccinated and those few who do
not respond to the vaccine.

Immunisation schedules, recommendations and vaccines are continually


being revised and vary from state to state. Because it is impossible to keep
the information absolutely up to date in a book, I am not including the
immunisation schedule here. All parents should receive a copy of the
vaccination schedule in the PHR book given to them after the birth of their
babies. Immunisation providers will advise you at the time of your baby’s
immunisation of available vaccine choices. If you are ever in any doubt
about aspects of your baby’s immunisation, please talk to your child and
family health nurse or family doctor.

The following diseases that can all cause serious complications and
sometimes death can be prevented by routine childhood vaccination—
diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps,
rubella, haemophilus influenzae Type B, hepatitis B, pneumococcal and
meningococcal disease, chickenpox and rotavirus.

What is the difference between vaccination and


immunisation?
Most people use the words vaccination and immunisation interchangeably
but technically the meanings are slightly different. Vaccination is the term
used to describe the process of giving the vaccine (by injection or
swallowing drops). Immunisation, on the other hand, is the term used to
describe both getting the vaccine and then becoming immune to the
disease. Immunity follows most vaccinations but not always.

How does immunisation work?


When bacteria and viruses make you sick your body’s immune system
fights off the disease by making antibodies which either kill the bugs or
render them harmless. Sometimes these antibodies continue to protect your
body from the disease long term (for example, measles) or the effect wears
off more quickly, which means you can become infected again (for
example, whooping cough).

Of course, catching a disease also exposes you to all sorts of complications


from the disease, including death and disability, so this is not the best way
to acquire immunity.

Vaccines are small amounts of a particular bacteria or virus which are


scientifically changed so they will not cause a disease but will make your
body produce antibodies to protect you from the disease. As the effect of
artificial immunity may wear off after a while, booster shots of some
vaccines are necessary to remind the body to keep making the antibodies.

Benefits and risks


Despite the fact that modern vaccines provide high levels of protection
against a number of debilitating infectious diseases and that serious
adverse effects are rare, there are a growing number of people in our
community who have reservations about immunisation. The small group of
activists who oppose immunisation are very vocal, present their arguments
with a great deal of fervour and provide good media copy.

Reports alleging that vaccines causes brain damage, autism, Sudden Infant
Death Syndrome (SIDS) and a range of other devastating conditions have
naturally caused great concern for parents and made many think twice
about submitting their healthy baby to such a perceived risk.

Unfortunately, the age when immunisation is given coincides with the time
in early childhood when SIDS and brain damage caused by fits is most
likely to happen. When babies are immunised there is a chance that either
of these things might happen as an unrelated event following immunisation
or the slight possibility the vaccination will bring on a problem that was
about to happen.

Understandably, the parents of the small number of babies who appear to


have had serious damage as a result of immunisation will have strong
concerns about the process for babies in general.

How safe are vaccinations?


No vaccine is one hundred per cent safe, but the unpleasant side effects
they cause in some babies are relatively minor and reversible. Serious
adverse reactions to vaccines are not only extremely rare but are
significantly less common and less severe than the diseases the vaccines
prevent.

Good evidence is available showing that vaccines do not cause HIV/AIDS,


allergies, asthma, Sudden Infant Death Syndrome, autism or multiple
sclerosis.

Babies who are not immunised because of parental choice are protected
because the majority of babies are immunised, not because the diseases no
longer exist or because the unimmunised have healthy lifestyles and eat
the right food.

Homoeopathic ‘vaccines’
Homoeopathic vaccines are not effective in preventing childhood diseases.
They are also not put through the stringent safety tests the recommended
vaccines have to undergo to make sure they work and are safe. The
Australian National Natural Therapists Association does not advocate
using homoeopathic remedies as an alternative to orthodox immunisation.

How effective are vaccines?


Most vaccines are not totally protective and become less protective as
community rates for immunisation fall. For example, the combined
measles, mumps and rubella vaccine is 95 per cent effective, so
approximately 5 per cent of babies will not be immune following their
vaccination. Three doses of whooping cough vaccine protects about 85 per
cent of babies who have been vaccinated and will reduce the severity of
the disease of the other 15 per cent if they do catch whooping cough. In
general, illnesses are shorter and less complicated in vaccinated babies.

Finding out the facts


We now have generations of children who have been protected from
diphtheria, tetanus and polio, so many parents today don’t understand the
serious threat these diseases once posed. I regularly speak to parents who
justifiably feel they need more information before they are prepared to
undertake a procedure which they feel may risk the health of their baby. It
is outside the scope of this book to list the volume of scientific data
supporting childhood immunisation programs. For recommended books
please see Further Reading in chapter 12.

Routine immunisation
Procedures
Some vaccines are combined, meaning fewer injections.

It is recommended that injected vaccines be given in the thigh to babies


under twelve months as often as possible and in the top part of the arm if
they are over twelve months.

Giving the injection into the buttock is not recommended because of the
risk of nerve damage and because the fatty tissue in the buttock may stop
vaccines working as well as they should.

It is also recommended that all vaccines due are administered on the one
visit. This does not cause problems for the baby, avoids unnecessary
expense and inconvenience and makes it easier for parents to keep track of
the schedule and make sure no vaccines are missed.

Availability and cost


Immunisation is available from your family doctor, children’s hospitals,
some local councils and sometimes in child and family health centres. If
you are unsure of where to have your baby immunised, your child and
family health nurse can give you details of what’s available in your local
area.

In Australia most vaccines are free. Currently the chickenpox vaccine is


not. Some councils charge a small fee and some family doctors charge a
consultation fee over and above the Medicare fee.

Maternity Immunisation Allowance


This is a tax-free payment from the Federal Government to parents whose
toddlers are fully immunised by eighteen months. The allowance must be
claimed before the toddler turns two.

To receive the allowance she must be enrolled on the Australian


Childhood Immunisation Register (ACIR) where her immunisation status
is recorded. All babies are automatically put on the ACIR when they are
enrolled with Medicare at birth. Registered providers (family doctors and
others) forward details of immunisations to the ACIR.

Keeping records
It is important to get a written record of your baby’s vaccinations in your
baby’s Personal Health Record as you will need this to confirm your
child’s immunisation status at various times. Your baby’s immunisation
status is linked to accessing the Child Care Benefit (CCB). To help
increase Australia’s immunisation rate the childcare rebate is only
available for babies and toddlers who have proof of up-to-date
immunisation or have an exemption.

Finding your way around the system


Phone the Immunisation Hotline on 1800 671 811.

Visit the Immunise Australia website at www.immunise.health.gov.au

If your immunisation record is lost, you or your family doctor can


obtain the details from the Australian Childhood Immunisation Register
by phoning 1800 653 809.

Two websites full of information about the Commonwealth Childcare


Rebate, Childcare Assistance and the Maternity Immunisation
Allowance are www.hic.gov.au (Health Insurance Commission) and
www.centrelink.gov.au (Centrelink).

Alternatively, you can phone the Family Assistance Office on 13 61 50.

Schedules
You might wonder about the rationale behind the schedules for
immunisation. For example, why start at two months for some and twelve
months for others? Vaccines are given at the youngest age at which they
will work the most effectively. Delaying vaccination or giving test doses
of vaccines is illogical and unsound. It puts the baby at risk of catching the
diseases she could otherwise be protected from at an age when she needs
the protection the most.

Adverse events following immunisation


Since the introduction of the acellular pertussis (whooping cough) vaccine
the number of babies experiencing adverse reactions to immunisation has
decreased. The use of the refined vaccine has reduced the incidence of
pain and fever associated with the previous whole cell pertussis vaccine by
about 30 per cent. In line with this the routine use of paracetamol before
vaccination is no longer recommended.

Many babies do not have any adverse reactions to their immunisation.


When they do the symptoms are usually mild—local reactions such as
soreness, redness, itching or burning at the injection site for one or two
days. Systemic reactions include fever, rashes, drowsiness and general
discomfort that may make the baby grizzly and unsettled for one or two
days. About 5 per cent of babies experience fever, rash, cold symptoms
and/or swelling of the salivary glands (under the jaw) five to twelve days
after the combined measles, mumps and rubella vaccine (MMR).

Rarely, a baby may become pale, floppy and unresponsive between one
and twenty-four hours following immunisation. This frightening event is
called a hypotonic episode and happens to only a minuscule number of
babies. It is usually associated with either of the pertussis (whooping
cough) vaccines, but is less likely with the acellular vaccine. A hypotonic
episode can happen with other vaccines, suggesting that the pertussis
components are not the only factors contributing to such an event.

Fortunately, follow-up studies show that all babies fully recover from
hypotonic episodes and do not have repeat episodes with subsequent
vaccines.

Treating adverse reactions


If necessary, give a single dose of paracetamol to lower fever if the
fever goes above 39°C. Paracetamol preparations are now available in a
variety of strengths and doses, so it’s important to calculate and
measure the dose correctly according to the manufacturer’s instructions.
Paracetamol is not a sedative, but it has a mild sedative effect on some
babies the first or second time it is used.

Give extra fluids.

If adverse reactions following immunisation are severe and persistent,


or if you are worried for any reason about your baby, contact your
family doctor or nearest local hospital.

Serious or unexpected adverse reactions related to immunisation are


monitored by the Department of Health and your state or territory
Health Department should be notified. Please tell your family doctor
about any such occurrences.

Contraindications to immunisation
Instances when immunisation cannot be given are virtually non-existent,
but unfortunately sometimes health professionals are nervous about being
blamed for times when babies do experience adverse reactions and may
unnecessarily delay or withhold immunisation or make it difficult for
parents to comply with the schedule. For example, insisting on different
visits for different vaccines.
These are not reasons to omit or postpone
immunisation
A simple febrile convulsion or a pre-existing neurologic disease.

A family history of convulsions or SIDS.

Asthma, eczema, hay fever, runny nose, snuffles or allergies.

Treatment with antibiotics.

Treatment with inhaled cortisone or cortisone cream.

Recent or imminent surgery.

If the baby is being breastfed.

If the baby’s mother is pregnant.

A history of jaundice following the birth.

Cerebral palsy, Down’s syndrome or autism.

Contact with an infectious disease.

Premature babies
Premature babies should be vaccinated according to the recommended
schedule from the date of their birth, not the expected date of birth.

Let the doctor or nurse know the following when you


take your baby for her vaccination
If your baby has a major illness and/or a high fever that day.

If she has ever had a severe reaction to any vaccine.

If she has any severe allergies.

If she has had a live vaccine within the last month (MMR, tuberculosis,
oral polio vaccine or yellow fever).

If she has had an injection of immunoglobulin or a whole blood


transfusion in the last three months.

If she has an immunity-lowering disease (leukaemia, cancer,


HIV/AIDS) or is having treatment which lowers immunity (steroids
such as cortisone and prednisone or radiotherapy and chemotherapy).

If she lives with someone who has a disease which lowers immunity or
lives with someone who is having treatment which lowers immunity.

If she has a medical condition which affects the brain or spinal cord.

If she is living with someone who is not immunised.

Because vaccine combinations and schedules vary from state to state, and
change so often, I am not including an immunisation schedule. All parents
should receive a copy of a vaccine schedule in their Personal Health
Record book given to them after the birth of their baby. Immunisation
providers will advise you at the time of your baby or toddler’s
immunisation of available vaccine choices.

MAJOR SAFETY HAZARDS AND PRECAUTIONS:


BIRTH TO 3 MONTHS
Most safety hazards remain throughout early childhood. The chart
emphasises specific hazards associated with developmental stages at this
age.
Age Stage Hazards Precautions

Suffocation by:
Remove plastic covering
plastic sheeting from mattresses
propped bottle Safe use of dummy and
bottle
dummy held in position by a rolled-up towel

tight clothing around neck Check baby clothing

Little motor control– Check water temperature


0–8
may lift head when on Burns and Scalds: before putting baby into
weeks
tummy the bath
Bath water too hot Don’t handle hot liquids
and the baby at the same
Hot drinks spilt on baby time

Heat Exhaustion: Open all car windows

Baby left in car on a hot day Never leave a baby alone


in a parked car

Falls: Never leave a baby


unattended in an elevated
From change table, lounges and beds
position
8–12
May roll over
weeks Strangulation: Make sure gaps between
Head caught between cot bars rails on cots are between
50–80mm

Injury:
Do not give sharp or
8–12 Holds given objects for Babies of this age are unaware of what they are
breakable objects to a baby
weeks short periods holding and have no control over their fine
to hold
motor skills

FOR MORE INFORMATION


Chapter 5: Choosing Baby Products

Chapter 10: Early Worries and Queries (medicating your baby)

Chapter 13: Growth and Development

FURTHER READING
Vaccination: the facts, the fears, the future, Gordon Ada and David Isaacs, Allen & Unwin,
Australia, 2000.

Other than this book and the information published by the government and National Health and
Medical Research Council, there is little available to parents outlining the objective scientific
evidence underpinning immunisation. While I recommend this book for all interested parents
because of its rigorous scientific approach, I have to admit it is not an easy read. The material is
excellent but, sadly, the style is not particularly user-friendly and the index is terrible.

NH&MRC, The Australian Immunisation Handbook, 9th edition, AGPS, ACT, 2013.

The following booklets are available from the Commonwealth Department of Health and Ageing.
(To obtain copies call the Immunisation Hotline on 1800 671 811 or go to their website at
www.immunise.health.gov.au)
13

Growth and Development


Previous chapter | Contents | Next chapter
Watching your baby grow and develop is such a miracle you are bound to
find it one of the most joyful aspects of having a child. The rate at which
babies grow and develop often causes confusion because of the wide
variation in age for achieving a lot of the milestones and because what is a
delightful stage for some parents is stressful for others. For example, the
toddler years may be a joy for some while others find a certain night
marish quality about the antics that go on during this time.

Constantly hearing how dreadful the next stage will be from well-meaning
friends can be annoying. Remember, every parent’s experience is different
at every age and stage of their baby’s development so try not to listen to
tales of doom about future stages.

Despite the normal variations in baby and toddler milestones, you will find
there is a basic pattern common to all babies. They smile before laughing,
hold things before reaching out and grabbing, and usually sit before
walking. Babies often achieve milestones then forget about them
temporarily. It’s not unusual for them to repeat actions like waving,
clapping, rolling or making talking noises over and over again only to stop
suddenly for a while. As long as they continue to grow and learn new
things this is nothing to worry about.

What is growth?
Growth refers to an increase in size. This is easy to gauge by measuring
weight, length and head circumference. Most babies who are given the
right food grow as they are meant to. Normal growth in healthy babies is
quite obvious as they move from bassinets to cots and from restraints to
car safety seats.

Health professionals use prepared charts for assessing height, weight and
head circumference. These charts are called percentile charts and represent
measurements of babies and children of a certain population (for example
—all babies in a particular state in a certain year). As normal variations in
height and weight are considerable, the results are drawn on a graph in
measurements of a percentage in order to allow for all the variations. The
lines on the graph represent the fifth, tenth, twenty-fifth, fiftieth, seventy-
fifth, ninetieth and ninety-fifth percentile. Most babies’ weight and length
fall somewhere between the fifth and ninety-fifth percentile. Allowances
have to be made for premature babies.

Understanding the charts


If your baby is on the fifth percentile for height and weight, it means 95
per cent of other babies her age are heavier and taller than she is. If your
baby is on the ninety-seventh percentile, 3 per cent of other babies her age
are heavier and taller than she is. Both lots of measurements are within the
normal range.

Sometimes the concept of percentile charts is hard to grasp. Here’s another


way: imagine your baby in a room full of other babies her age. If she is on
the third percentile, most of the other babies in the room would be bigger
than her, but if she is on the ninety-seventh percentile she would probably
be one of the biggest babies in the room.

Percentile charts are useful as they are a visual way of understanding your
baby’s growth as well as seeing the wide range of measurements which are
normal. Your baby will follow her own growth pattern which depends a lot
on family characteristics. Comments from onlookers such as ‘what a
big/small baby’ are nearly always false perceptions based on unscientific
observations. If someone’s comments alarm you, ask your child and family
health nurse or doctor to plot your baby’s measurements on a percentile
chart. Ask to see the chart, and if you don’t understand it ask for an
explanation. It doesn’t matter which percentile your baby is on as long as
growth is consistent and height and weight are in reasonable balance.

Interestingly, by the time they are three years old, only a small number of
babies are on the same percentiles they start out on. Head circumference
can also be charted on the percentile chart. Baby heads are measured
because their rapid growth in the first year makes it easy to check that they
are growing at the right rate.

What is development?
Development refers to your baby’s ability to learn all the skills she needs
to enjoy a good quality of life. To a large extent development comes
naturally to healthy babies who have plenty of love and attention.
Development includes things like movement, language, toilet training and
play. We tend to take all these functions for granted, but the acquiring of
them is amazingly complex.

Developmental achievements are referred to as milestones. Milestones are


grouped under the following headings:

Gross motor
Involves control of large muscles. These skills enable babies to sit, walk
and run.

Fine motor
This refers to the ability to control small muscles. These skills enable
your baby to manipulate so she can hold a rattle, pick up objects and
eventually scribble with a pencil all over your walls.

Vision
Vision is the ability to see near and far and interpret what is seen.

Hearing and speech


Hearing is the ability to hear (receive) and listen (interpret).

Speech is the ability to understand and learn language.

Social behaviour and play


These skills enable your baby to learn socially acceptable behaviour.
They involve things like eating, communication and personal
relationships.
A number of factors may affect growth and development. Some cause
delay which may be temporary or sometimes permanent, while some may
advance babies in certain areas.

Genetic influences
Genetic influences can have quite significant effects on growth and
development. Small, thin parents are likely to have small, thin babies. A
father with a large head may have a baby with a large head. Special
talents such as musical and sporting abilities often appear through
generations.

Prematurity
Any baby born at less than thirty-five weeks (compared to forty weeks
for a full-term baby) needs an allowance made for prematurity. For
example—if birth was at thirty weeks, ten weeks is subtracted from the
baby’s age from birth in recognition of the fact she is likely to attain her
milestones up to ten weeks later than a baby born at forty weeks.

By the time most premature babies reach their fourth birthday, four out
of five have caught up with their peers and many catch up long before
this.

Illness and/or prolonged hospitalisation


If your baby has to spend any length of time in hospital development
may be temporarily delayed.

Babies who have major surgery may be late acquiring a few specific
skills. This usually rights itself once they are back in their own
surroundings. A long debilitating attack of diarrhoea or the flu can
delay milestones temporarily.

Babies born with problems


A small number of babies are born with specific problems which will
greatly affect their growth and development. Babies with conditions
such as Down’s syndrome, spina bifida, cerebral palsy and so on need
special help with their development so they can live the best quality of
life possible.

Environmental and emotional deprivation


Developmental delay is a risk when a baby is being raised in an
unstable, unsafe environment. This may be due to parental neglect or
because of war, famine or poverty. I must emphasise however that most
developmental delay is due to factors outside the parent’s control, not
because the parent has done the wrong thing.

Growth: birth–3 months


Average birthweight is around 3175 grams (7lb) but healthy newborns can
weigh anything from 2608 grams (5lb 12oz) to 4535 grams (10lb) or more.
In general, boys tend to be a little heavier than girls, although there is great
variation within this overall trend.

Weighing babies is just one way of checking on your baby’s general


wellbeing and by no means an essential part of her care. First babies seem
to be weighed much more frequently than subsequent babies, who survive
just as well.

Weighing is a useful guide for:

Working out whether the breastmilk supply is low.

Working out whether unsettled behaviour in babies under six months is


due to hunger or other factors.

Adjusting the diet of a baby who is underweight.

Adjusting the diet of a baby who is overweight.


Constantly weighing your baby under the supervision of an unsympathetic
health professional can cause great stress, especially if you are
breastfeeding for the first time. Weekly weighing is not necessary unless
you feel like it or there are specifically defined medical reasons for doing
so.

Work out some sort of weighing routine that you feel comfortable with or
if you are happy all is well, give it a miss completely if you don’t feel like
it. It’s advisable to weigh your baby on the same scales when possible as
different scales give different results.

Weight gains in the first three months


Your baby loses about 10 per cent of her birthweight in the first three to
four days. This is caused by loss of extra body fluid, passing meconium
(her first poo) and a limited food intake. She will probably regain her
birthweight by the time she is ten days old, if not before.

Some babies need extra time to start gaining weight so don’t panic if the
weight is a little slow, especially if you are breastfeeding. As long as your
baby has good muscle tone, is vigorous, sucking well and has six to eight
pale, wet nappies a day, relax and carry on. From two to three weeks
onwards babies gain anything from 150 to 450 grams (5oz to 1lb). Weight
and length never mean as much taken on their own as they do taken
together and plotted on a percentile chart so an overall pattern of growth
can be seen.

Length
Average length at birth is between 48cm and 56cm (19 inches and 22
inches). You will almost certainly find a discrepancy between the birth
measurement and the next visit soon after birth at your doctor’s or child
and family health centre. Measuring babies accurately needs two people
and the right equipment which is not available at birth, so don’t worry if it
appears your baby has shrunk or turned into a giant on the second
measuring.

During the first three months your baby will grow about 1.9cm (¾ inch) a
month. Length increases in spurts every few weeks so weekly measuring
frequently shows ‘no growth’. Measuring every three to four weeks is
much more rewarding.

Reflexes
It’s a good idea to know a little bit about baby reflexes. Apart from being
interesting, it helps explain some of the strange things babies do. Some of
the settling techniques suggested for unsettled babies relate to some of
these reflexes.

What are they?


Reflexes are automatic responses to nerve stimulation and a number are
present in new babies. Some you will be familiar with as they persist to a
lesser degree throughout life, such as jumping at a loud noise; sneezing;
gagging; yawning; coughing; blinking.

Other reflexes are peculiar to babies and disappear at various times in their
first year. Many of the things your baby does happen because she doesn’t
have control over many of these reflexes; however, recent research
suggests some baby reflexes are accompanied by voluntary, intentional
movements. Turning the head and seeking the breast, and taking the breast
and sucking are thought to be examples of this.

Reasons for baby reflexes

Survival and protection


Certain reflexes are needed for life outside the womb so babies can obtain
nourishment and breathe. Reflexes involved in obtaining nourishment are
the rooting reflex, the sucking reflex and the swallowing reflex (these are
explained in chapter 13). An example of two reflexes involved with
breathing are yawning and the way a baby automatically turns her head to
one side to breathe when placed on her tummy. Examples of protective
reflexes are blinking, gagging and coughing.

For living life in the womb


Crawling and walking reflexes are directly related to life in the womb.
Babies use their feet to push off the side of the womb as they move about
inside the womb during pregnancy, so after birth if pressure is applied to
the soles of their feet they respond by ‘stepping’ or ‘crawling’. These
reflexes have nothing to do with later crawling and walking and are gone
by four weeks.

Primitive reflexes
I find the most fascinating reflexes are those thought to be related to early
humans. These are called primitive reflexes.

Grasp reflexes in hands and feet are there in memory of an age where it
was necessary to clutch onto fur. Your baby will demonstrate the grasp
reflex by closing her fingers over your forefinger if you place it in her
hand. She will also grasp anything else that comes in contact with her palm
such as your long hair, the chain around your neck, the side of the bath or
her father’s hairy chest.

Touching the soles of her feet will make her toes curl.

Grasping fingers and clenched fists start to lessen after three months. The
grasping toes don’t disappear until she can stand alone.

Another primitive reflex is the Moro reflex. Any jarring or sudden change
in your baby’s balance will make her throw out her arms and legs. The
Moro reflex is very strong for two months and gone by three to four
months. Here are some other reflexes you are bound to notice.

List of reflexes

Sucking
The sucking reflex is a powerful one. Not all the sucking your baby does
relates to hunger and food. Babies frequently suck on objects even when
they are not hungry, especially when they are over-tired or upset. This is
called non-nutritive sucking and appears to be an inborn, natural thing that
babies do to relieve distress. Some babies need to do this more than others.
The sucking reflex is replaced during the first few months of life as
voluntary sucking takes over when objects are placed in the baby’s mouth.

The rooting reflex


When your baby’s cheek is touched either on purpose or accidentally she
will turn her head in the direction of the touch and open her mouth to suck.
Parents often mistake the rooting reflex as a sign of hunger. Your baby
does do this when she is hungry, but she will also behave like this lots of
times when she is awake and stimulated, whether she’s hungry or not. The
rooting reflex is very strong for three to four months and may be present
for up to a year.

The startle response


Noise, a sudden movement or your baby jerking herself awake will make
her fling out her arms and legs, cry and become upset. These reflexes often
make it difficult to settle young babies because they keep waking
themselves up, which is why some settling techniques involve wrapping or
holding your baby firmly to help her get into deep sleep.

The quivering lip


Sudden noise, movement or change of your baby’s posture often starts the
bottom lip quivering, which in an older child or adult indicates emotion or
cold. The quivering bottom lip in a young baby is another reflex and not
indicative of either of these things; it is due to external stimuli such as
being undressed or disturbed.

The gag reflex


Gagging is an automatic response to stimulation of the lower part of your
baby’s throat. It is our bodies’ natural defence to unsuitable things going
down the throat and persists throughout life, but the gag reflex is very
exaggerated in babies compared to the gag reflex in adults. It can be quite
significant in older babies, who gag a lot when they are given finger food
or lumpy food—parents often mistake this for ‘choking’.
Development: newborn to six weeks
Gross motor
When your newborn lies on her tummy, you will notice she lies with her
arms and legs curled up because of the way she has been lying in the
womb. If she was born bottom-first, her legs will not curl up as much.

Most newborns lift their heads while they are on their tummies and turn it
from side to side if only for a second. They do this to ‘gain their balance’.

If you lie her on her back and pull her gently towards you, her head will
fall back behind her body. This is called ‘head lag’ and is why it’s
important to support your baby’s head when she is being held, fed or
bathed.

Fine motor and vision


Fine motor: Your baby grasps objects that come in contact with the
palm of her hand.

Vision: Your baby is able to see from birth. Young babies are short-
sighted, so brightness and movement will attract your baby’s attention
and faces and eyes are the things she focuses on best. Hold your face
close to her face, move it slightly from side to side and watch how she
follows you with her eyes. Do it any time after birth when she is relaxed
and alert.

Hearing and speech


Hearing: Your baby is able to detect a loud noise and respond with a
startle reflex (a jump) from birth, but you will find her response is not
there for every sudden loud noise. When she is sleeping deeply, crying,
distracted or feeding, a sudden noise will often make no impression
whatsoever. You may find when you try to make her jump by clapping
or banging a door there is no response, so don’t worry the life out of
yourself by continually trying to ‘test her hearing’. Newborn screening
for hearing babies is now routine for all babies in Australia and any
problems should be identified early (see below). After a few weeks you
will start to notice she does start to spontaneously respond to noises
such as an adult coughing or sneezing, keys rattling or a dog barking.

Newborns respond selectively to different sorts of sounds. A soft noise


such as a ‘whooshing’, music or a lullaby can soothe and calm your
baby while a loud, jarring noise has the reverse effect. She will also
stop crying at times to listen to your voice.

About one to two babies per thousand are born with significant hearing
loss. Early diagnosis and intervention markedly improves their
communication and their educational, social and emotional
development. Newborn hearing screening programs aim to identify
these babies and introduce them to the appropriate services as soon as
possible.

Each state in Australia runs their own newborn hearing screening


program, often undertaken in maternity hospitals but also in the
community. If you miss out or have a homebirth make enquiries to your
midwife, your local maternity hospital or your child and family health
centre as to where you can have your baby’s hearing tested.

It is important to remember that, regardless of the screening result, if


you ever have concerns about your baby’s responses to sound or
development of speech and language, you should arrange to have her
hearing tested again and/or consult your family doctor, child and family
health nurse or paediatrician.

Speech: Until your baby starts to coo and make other noises from about
six weeks, crying is her only vocalisation, although not her only form of
communication. She does have other more subtle ways of
communicating such as grasping your finger, staring intently at your
face and coming off the breast when she wants to, but crying is the form
of communication you’re likely to be most aware of in the early weeks.
The amount and duration of crying is highly variable between babies.
Some babies cry infrequently and only then for an obvious reason,
others confuse and bewilder everyone by crying for long periods of
time for reasons impossible to work out.
Baby sign language is popular, although the fad seems to be
diminishing. It is a collection of easy to remember simple gestures
(signs) that babies can learn to use before they can speak. The aim of
baby sign language is to be able to communicate in meaningful ways
with babies and so find out what is troubling them and fulfil their every
need. The companies involved in selling the baby sign language
method(s) claim a host of advantages such as IQ enhancement, an
ability with languages and reduction of temper tantrums, tears and
frustration. The research cited to support the seemingly amazing
benefits of baby signing has predominantly been conducted by
psychologists who have vested commercial interests in the system. But
to be fair, there is also plenty of anecdotal praise for baby signing from
parents worldwide. However, as it’s difficult to find any objective
research by independent researchers to support the claimed benefits, I
view baby signing as a non-essential option. By all means try it if the
idea appeals but before you commit yourself to something you may find
not only costly but onerous take note of the following statement by
Speech Pathology Australia:

It is the position of Speech Pathology Australia that the best way to


successfully stimulate children’s speech and language development is
by talking to them and sharing joint experiences. Using baby sign is not
necessary for successful language acquisition. If parents wish to use
baby sign with their children, Speech Pathology Australia encourages
them to accompany signing by talking. Research does suggest that the
use of augmentative communication, such as sign, is beneficial for
children with developmental delays and/or those who are at risk of
speech and language difficulties.

Social behaviour and play


Many of your baby’s reflexes are outside her control, but you will notice
there are times when her response to things is intentional. Research in the
last few decades shows that newborn babies are capable of responding
purposefully and making choices. Responding to your voice and being
comforted by rocking, sucking, cuddling or skin-to-skin contact are all
examples of this. Your baby is aware of differences between tastes—from
a very young age babies frequently reject water but drink breastmilk or
formula eagerly.
Development: six weeks
Gross motor
By six weeks your baby has noticeably more head control, so you will find
you don’t have to support her head as much when you lift and hold her.

Hearing and speech


Hearing: Sudden noises will make your baby jump, although there are
still times when she doesn’t respond.

Speech: Between five and eight weeks she will start to make beautiful
gurgling, cooing noises when you talk to her. The first responsive
noises babies make are magical sounds.

Social behaviour and play

Along with the cooing noises the first smile appears—and what a moment
that is! A small number of babies smile as early as ten days, occasionally
soon after birth. People love to refer to early smiling as ‘wind’. A non-
communicative grimace, which is very common for babies to do,
especially when they are sleeping, is not a smile (nor is it ‘wind’); but
when your baby looks at you and smiles in a way that is definitely
communicative, ignore suggestions of ‘wind’—it is a smile! The average
age for the first smile is between five to eight weeks.
Development: three months
Gross motor
At three months your baby has almost full head control with sometimes
slight head lag when you pull her towards you from a sitting position. If
she doesn’t mind lying on her tummy, she will prop herself up on her arms
and crane her head around, practising her balancing and getting a grand
view of the world. When you hold her standing on a firm surface she may
bear her weight, sometimes sagging a bit at the knees. Lots of babies love
to stand and bear their weight from as early as eight weeks. If your baby
does, you will not cause her any harm by letting her stand as much as she
wants to (as long as you have the patience to hold her—some babies like to
stand all day). It is a myth that early weight bearing causes ‘back
problems’ or makes babies bandy-legged, so ignore comments suggesting
this.

Vision and fine motor


Vision: By three months babies can’t get enough to look at. Between
three and five months you might find feeding becomes tricky because
of the way your baby is constantly distracted by everything around her.

Human faces and eyes still hold the most interest, especially yours. She
will now follow your movements around the room.

Fine motor: At around this time you will notice your baby’s fists and
fingers are never out of her mouth. Continually putting her fists and
fingers into her mouth is part of your baby’s sensory-motor
development and not a sign of teething or hunger. Nor is it a ‘bad habit’
you have to do something about. There’s no need to put mittens on as
it’s important for your baby to have access to her fingers.

All babies do this to some degree, replacing fists and fingers with
objects when they are old enough to deliberately grasp things to put into
their mouths. They have an in-built internal drive that motivates them to
explore and find new stimuli so they can learn about the world around
them. As well as this, three to four months is the age babies start to do
things intentionally. When your baby sees her hands drifting past her
face she puts them into her mouth on purpose and keeps repeating the
action, at times frantically pushing her fists so far in she makes herself
gag. The ‘everything in the mouth’ stage remains constant throughout
the first year and gradually decreases during the second year.

When you place a rattle in your baby’s palm she will grasp it and wave
it aimlessly, not really knowing she’s holding it. Eventually it just drops
out of her hand spontaneously without her being aware that it has gone.
She will not look for it. Hand-to-eye co-ordination enabling babies to
know they are holding something and to deliberately put objects other
than their hands in their mouths starts between four and five months.

Some time between three and four months your baby will start to clasp
and unclasp her hands and to look at them a lot.

Hearing and speech


Hearing: Your baby now responds more consistently to loud noises. In
fact, being super-sensitive to loud or sudden noises is normal for a lot
of babies this age (especially the noise of the vacuum cleaner). She also
gets excited at the sound of approaching voices or footsteps.

Speech: The ‘cooing’ quickly becomes constant vocalisation (talking


noises) which has a delightful musical sound.

Chuckling and laughing starts at around three months.

Social behaviour and play


Three to four months is a delightful age. When your baby wakes she
probably makes lots of tuneful noises now instead of crying, particularly in
the mornings. Most babies of this age really enjoy their baths—although if
your baby doesn’t, it doesn’t mean anything is wrong. She will love to be
tickled, played with, talked to and sung to.
Variations in milestones
Developmental milestones are geared to about the middle 50 per cent of
babies. They do not allow for the two extremes of the developmental scale
which are still normal. Try not to worry yourself needlessly by comparing
babies or expecting a milestone to happen the day your baby turns a
certain age.

Normal variations are greatest in the gross motor area. Here are the
commonly noticed variations in the first three months.

Rolling: From four weeks to nine months. Involuntary rolling can


happen from as early as four weeks, so never leave your baby on an
elevated surface and walk away.

Head control: Some babies develop strong head control very early,
others still have wobbly heads that bob forwards at three months.

Supporting weight when held on a flat surface: From eight weeks to


nine months.

Smiling: Ten days to eight weeks.

Responsive cooing noises: As early as a few weeks to eight weeks.

Tuneful talking noises: From seven weeks to three months.

Stimulating things to do
Parents today are bombarded with ways to provide ‘optimum’
development. Many find the feeling that they should be constantly
involved in stimulating activities, flashcards, musical appreciation,
swimming lessons and baby gym overwhelming, especially when there
don’t seem to be enough hours in the day to do the necessities, let alone
endless activities.

Remember, your baby is part of your family. Being part of a family


involves times for housework and maintenance, personal time for each
family member and times when everyone is together. A healthy baby given
the proper food and plenty of attention in a loving home will grow and
develop at her own rate as she is meant to. Extra activities are great when
you have the time and money or when it provides a social outlet you both
enjoy, but there are lots of simple things you can do that are not greatly
time-consuming and do not cost much.

Here are some suggestions for the first three months:

Walking: It’s fine to prop your baby up as soon as she is taking an


interest in the world at large. Just make sure she is secure and not able
to tumble out when you go over a bump.

At home she will like looking at mobiles hung about 30cm from her
cot. Make sure the mobile is always out of your baby’s reach. Mobiles
can be changed from time to time.

From as early as two to three weeks your baby can sit in a portable baby
chair so she can see what’s going on around her.

Lots of babies enjoy lying on some towels on the floor without their
nappies on.

A selection of inexpensive toys that your baby can start to learn to reach
for helps her hand-eye co-ordination. Things that squeak or make an
interesting noise are popular, as are dolls with realistic faces and
wobbly toys that bounce back when swiped at.

Your face, your eyes, your voice and your touch are the most important
learning and entertaining things for her.

A word about ‘tummy-time’


My original aim when I wrote Baby Love twenty years ago was to try to
give parents less to worry about but as each year goes by this becomes an
impossible dream, as the teetering mountain of baby research casts its
shadow over every parenting moment and sadly much of it cannot be
ignored. The compulsory tummy-time advice first hit the decks in the
1980s when some physiotherapists decided that daily tummy-time
strengthened baby’s back and neck muscles, encouraged head control and
co-ordination and was a great aid in helping baby learn to crawl. Some
even suggested (incorrectly) there was a link between tummy-time and
baby’s future reading ability. Those of us working in the area could see
that tummy-time was advantageous for babies with specific disabilities or
premature babies who need a variety of guided exercises to enhance their
development but it was very hard to see that it was necessary for the
majority of healthy, normally developing babies who, we observed, learnt
to crawl, walk and otherwise develop the way they were meant to without
daily tummy-time. The push for compulsory tummy-time gave mothers yet
another job to do, which was frequently stressful because the babies by
and large didn’t like it too much.

However in view of the flat head concerns (see chapter 10) and the slight
delay in rolling over, pulling up and crawling that is occurring because of
sleeping babies on their backs from birth I now feel obliged to go along
with the idea. Floor time has always been a good thing for babies as it
encourages a range of movements on a nice firm surface. Try for regular
tummy-time as often as you can. Some babies do enjoy it, others learn to
enjoy it (‘you vill haf your tummy-time’) and others, unfortunately, always
seem to hate it.

Encouraging babies to get used to tummy-time involves lying down with


your baby face-to-face and talking to her and amusing her while she lies
there. The aim is to try to extend the time each day until she loves it so
much you can leave her to her own devices for a while.

Have fun, especially if you’ve got a toddler who wants to sit on your back
while you’re down on the floor doing tummy-time with baby.

Toys
Toys are very much related to your baby’s development. In the first three
months toys and activities are centred around stimulating your baby with
sounds and small movements. Here are some suggestions for the first three
months:

Rattles, squeakers and shakers.

Mobiles: Your baby will like to look at a mobile from a very young
age. Black and white geometric shapes with pictures of faces create
great interest.

A pull-the-string music box hung out of reach keeps young babies


interested and can help them settle.

One or two soft, washable toys for company.

Between eight weeks and three months your baby starts to look straight
ahead, opens her hands some of the time and starts swiping at things, so
a toy frame with dangling bits and pieces is a suitable toy at this age.

Clear, colourful pictures and/or a frieze or two around the walls creates
interest. It’s fun to walk around the room with your baby having a
conversation about the things and people in the pictures.

You don’t have to have wall-to-wall toys at any age. Babies and toddlers
do better with a few at a time and no matter how ideal the toy, their
attention span is limited, so they will become bored with anything after a
certain time which varies from baby to baby. Try not to have too many
unrealistic ideas of the entertainment value of toys. A few well-chosen
items that suit your baby’s age and stage of development are essential, but
there is no toy on the market that will keep any baby entertained for hours
every day or replace getting out of the house whenever possible or being
played with by parents or brothers and sisters.

Developmental summary: 0–6 weeks


Gross motor
lying on back—head goes to one side

pull to sit from lying—head falls back

when held sitting—back curves a lot

Vision and fine motor


pupils react to light

follows a face one-quarter of a circle

can see from birth—short-sighted

hands usually closed

grasps a finger placed in palm of hand (involuntary)

Hearing and speech


startled by a sudden noise

coos and smiles by six weeks

Developmental summary: 3 months


Gross motor
lying on back—head stays in the midline

pull to sit from lying, little or no head lag

when held sitting back curves slightly

lying on tummy usually lifts head

when held standing—may support weight, likely to sag at the knees

Vision and fine motor


visually very alert

follows a face and eyes half a circle

plays with hands—fists constantly in the mouth


holds a rattle if you place it in her hand but is unaware she has it

Hearing and speech


sudden noise distresses

vocalises tunefully

Social and play


usually enjoys bath

loves to be talked to and played with

FOR MORE INFORMATION


Chapter 8: Breastfeeding Your Baby After the First Two Weeks (breastfeeding, low supply;
breast refusal)

Chapter 12: Safety (toys)

Chapter 14: Sleeping and Waking in the First Six Months (startle reflex; crying patterns)

Chapter 15: The Crying Baby (crying patterns; weighing)

Chapter 24: Feeding Your Baby (gagging, choking)

FURTHER READING
From Birth to Five Years—Children’s developmental progress, Mary D. Sheridan, revised and
updated by Marion Crost and Ajay Sharma, ACER, 3rd edition, Australia, 2008.
14

Sleeping and Waking—The First


Six Months
Previous chapter | Contents | Next chapter
We are now moving into the trickiest and, in some ways, the most
controversial, area in the world of babies—that of baby behaviour. Tricky
because it’s often hard to interpret what baby and toddler behaviour means
before they have the language skills to tell us, and controversial because
research into human behaviour is difficult, particularly so with babies, and
you are likely to find a variety of opinions from health professionals as to
why babies do what they do. ‘Behaviour’ describes what babies do, or
don’t do, without making value judgements about their characters now or
their characters in the future.

Crying, waking and sleep mostly relate to baby behaviour and not to the
more tangible things you will keep hearing about like an ‘inexperienced
mother’, food or medical conditions. The term behaviour is not used as a
way of describing babies as being ‘good’ and/or ‘bad’. ‘Good’ and ‘bad’
are meaningless labels based on adult concepts that we persist in giving
humans at an age when they have not yet developed any control over their
behaviour. A lot of the way babies behave relates to them adapting to a
new environment by doing what they have been programmed to do for
thousands of years to ensure their survival.

A range of behaviour is observable and common to most babies, which is


what much of the advice given to mothers about crying, waking and
sleeping is based on, but it is vital to understand that:

Babies are unpredictable.

Frequently, clearly defined reasons to explain why the baby’s doing


what she’s doing do not exist, so there are no guaranteed solutions all of
the time to difficulties with sleeping, waking and crying.

Information about babies’ sleeping and waking often leads parents to


believe there is always an answer to making babies sleep and stop crying
and only one set of correct guidelines to follow. Unfortunately, experts in
babycare often think they have to solve problems and provide answers
when there are none, often giving mothers quite unrealistic goals. The
word ‘should’ seems to be used a lot. For example: ‘your baby should be
sleeping through the night’; ‘in the day your baby should be up for one and
a half hours then should sleep for one and a half hours’; ‘when your baby
wakes after twenty minutes she should be put back to sleep’ and so on.
The mother ends up feeling hopeless when the advice doesn’t work and
usually assumes it’s something she’s doing wrong or worse she has a ‘bad’
or sick baby. Most of the time, just knowing what’s normal, how long a
particular way of behaving is likely to last and that not that much can be
done to change what’s happening is the most helpful approach for the
mother and her baby.

Looking at all the safe options rather than attempting to ‘diagnose’, ‘cure’,
or ‘make’ healthy babies behave in certain ways, especially when we don’t
know exactly what their problem might be, sums up my approach. Giving
a diagnosis or one definitive answer may provide parents with short-term
relief but it is also limiting. Providing a full discussion and options allows
parents to make their own decisions about what it is they want to do.

Let’s look at sleep first


Babies have to learn to sleep; sleeping for long stretches on their own is
not something that comes naturally and some learn to do it quicker than
others. Babies are all different, so the individual range of sleeping and
waking they do varies considerably.

The way we sleep, whether we are babies or adults, is quite complex and
consists of various stages ranging from being awake to dreaming to light
non-dreaming to deep non-dreaming. Dreaming sleep is called rapid eye
movement sleep (REM).

Here is a simple description of the stages of sleep


Non-REM sleep varies from stages of drowsiness to very deep sleep.
When woken from very deep sleep we are slow to respond and
confused.

During REM sleep there is increased brain activity. If we are woken


from REM sleep we become quickly alert.

Brief wakings occur at various times between stages of sleep. During


the night the average sound adult sleeper wakes briefly up to nine times
a night, returning quickly to sleep a lot of the time unaware of waking,
so there is no such thing as ‘sleeping through’. ‘Sleeping through’ is a
term used to describe the way a baby sleeps through’ is a term used to
describe the way a baby sleeps who no longer disturbs her parents
during the night. The baby who ‘sleep through’ does in fact wake
throughout the night but puts herself back to sleep without waking her
parents.

When young babies are in REM sleep they twitch, breathe irregularly,
sometimes grimace (not a sign of ‘wind’) and flicker their eyelids. When
they are in non-REM sleep they lie very still. Breathing is much more
regular with an occasional sudden movement or startle which is enough to
wake some babies and start them crying.

How we sleep

REM sleep takes up to 50 per cent of a baby’s sleep cycle compared to 25


per cent in adult sleep cycles. During the first three months babies go into
a REM sleep cycle when they first fall asleep. By three months of age this
is reversed and the first stage of sleep is non-REM, which continues
through life. The entire sleep cycle (that is, passing through the various
sleep stages) takes around fifty minutes in a baby compared to ninety
minutes in an adolescent. Some researchers believe that the increased
amount of REM sleep in young babies may be an important factor in brain
development.

Just looking at baby sleep cycles alone, without even thinking of the usual
reasons given for erratic sleep (hunger, too hot, too cold, ‘wind’ and so on)
gives us some very good reasons why babies have such irregular sleeping
and waking patterns:

The increased amount of REM sleep means they wake more easily and
are often alert and ‘ready to go’ when they do wake and mothers
usually find it’s very difficult, if not impossible, to get their babies back
to sleep.

As young babies go to sleep via REM sleep it takes longer for them to
pass into non-REM and deep sleep, so there are times when helping
them go to sleep is also difficult.

Jerky movements or the startle reflex may wake them suddenly out of
deep sleep; this can happen after only an hour’s sleep. Again, getting
them back to sleep is difficult.

The brief waking from one stage of sleep to the next brings babies fully
awake. Until they learn how to put themselves back to sleep every time
it is normal for some of them to cry when they wake in between sleep
stages.

How much sleep do babies need?


I don’t think anyone knows for sure; the range for healthy newborn babies
varies from nine to eighteen hours every twenty-four hours. Some babies
either do not seem to need much sleep or cannot sleep more than nine
hours every twenty-hour hours. This makes them harder to live with as
they tend to get over-tired, which makes them crotchety, but it does not
harm them in any way.

Rather than look at what ‘should’ happen, I think it’s much more useful to
look at what ‘does’ happen with most babies’ sleeping and waking pattern
in the first three months.

Sleeping and waking variations in the


first three months
The first two to three weeks
Many babies start out eating and sleeping in very regular patterns. When
they cry it’s easy to work out what the matter is and everyone around the
mother says ‘what a good baby’. For many this doesn’t last long and by
week three they are starting to behave quite erratically—sleeping less and
crying more at times when no one can work out what the matter is.
Most common sleeping/waking pattern
One five- to six-hour sleep (if you’re lucky, during the night), a couple of
three-hour sleeps, several two-hour sleeps and up to five or six hours of
catnapping, interspersed with wakefulness and crying.

The unsettled period


Eighty per cent of normal, healthy well-fed babies have one session of
unexplained crying every twenty-four hours. This usually starts to happen
around three weeks and continues until they are eight to twelve weeks old.
The session of crying behaviour lasts from one and a half to five hours. It’s
often in the evening but may happen at any time. The other common time
is the unsociable hours just before dawn. I call this the ‘unsettled period’.

Why does it happen?


No one really knows because the baby can’t tell us. When your baby is
feeding well and sleeping well most of the time, apart from the unsettled
period, accepting it and working out ways to manage until she changes is
more important than trying to figure out exactly why it is happening. The
unsettled period is rarely anything to do with breastfeeding, the brand/type
of formula or burping techniques, although fond relatives will almost
certainly keep talking to you about ‘wind’ and ‘a little pain’. When such a
high percentage of healthy babies behave like this one can only assume it
is a normal response to the dramatic change of their environment from the
womb to the world as well as an inability to sleep at this time. They
become stressed and over-tired and are unable to either get to sleep or
enjoy being awake.

What can you do during the unsettled period?


Here are the options to think about until the unsettled period stops
happening (at about three months, if not before).

1. Give unlimited breastfeeds.

Babies often look hungry when they are unsettled because they seem to
want to suck all the time so some women just keep breastfeeding their
babies until they eventually settle. Peace is achieved for a while
whenever the baby is at the breast. The frequent breastfeeding does not
harm the baby but some women find the constant feeding exhausting
and notice in the long run their babies fuss and cry whether they are fed
a lot or not.

Babies having formula should not be offered unlimited amounts of


formula during the unsettled period as bottle fed babies cannot adjust
the volume of milk the way breastfed babies can, and may just keep
drinking whatever they are given. At best this makes them throw up and
at worst makes them overweight. As hunger is not the cause of the
unsettled period, try not to offer formula more than every two and a half
to three hours; keep to the amount your baby usually drinks at other
times.

2. Limit feeds, try other techniques.

Keep to your normal feeding pattern instead of breastfeeding


continuously. Give your baby one feed, offer a top-up an hour later (if
you’re breastfeeding) then wait the usual two and a half hours before
the next feed.

Instead of feeding:

Wrap, rock and pat: Try swaddling your baby firmly, arms down,
put her to bed and wheel or rock the bassinet. If she goes to sleep she
is more likely to stay asleep than if you put her to sleep at the breast
or in your arms and then put her down. (See Helping-to-sleep tips,
chapter 14.)

Keep her next to you (or give her to your partner) in a sling or front-
pack for as long as it is acceptable to you (or your partner). When
the unsettled period is in the evening, handing the baby over to
someone other than the mother helps. Some women find it upsetting
when their partner walks in and calms the baby fairly quickly. This
happens because an unavoidable level of stress builds up between
the baby and her mother when the baby is unsettled, so another
person who has not been with the baby all day can often break the
stressful cycle. When the father is the one at home all day the same
thing happens to him, so don’t feel it’s something you’re doing
wrong or that your baby doesn’t like you.

Try a bath: It doesn’t matter if she’s already had one that day. If
she’s been very unsettled and you haven’t fed her for a few hours, a
bath and a feed often does the trick—sleep descends.

Dummies: Using a dummy helps some parents and some babies. Not
all babies will take dummies and there are some negative aspects to
their use (see chapter 5) but if giving your baby a dummy brings
some much-needed relief, go ahead.

3. Limit feeds, allow some crying.

Leaving babies to cry is never easy. Some parents find it easier than
others and most parents find it easier when it is not their first baby.

Some parents are appalled by the very idea. Parents with twins and
triplets have to learn how to tolerate at least some crying.

There is much confusion and bad press surrounding the concept of


‘controlled-crying’—the idea of leaving your baby to cry instead of
feeding, nursing (‘wearing’), rocking, patting, taking baby to bed and so
on.

‘Controlled-crying’—or whatever else it may be called is a regime or


method that aims to get a permanent, predictable response within a
certain time by leaving babies to their own devices (crying) with timed
visits by a parent until they (the babies and hopefully the parents too)
go to sleep, the aim being that the baby will ‘learn’ to sleep, quite
quickly we hope.

I don’t think that it is possible or even appropriate to attempt to teach


babies much less than six months to sleep by leaving them to cry as a
planned strategy during either the day or the night. It is true that
sometimes these strict regimes appear to work quickly with very little
crying involved, probably because the baby was going to settle anyway,
rather than because of a particular guru’s ‘controlled-crying’—or
whatever other name it is given—strategy. It is equally true that there
are many times when the baby cries endlessly and the mother gets more
stressed trying to put the regime in place. Unlike some, I do not believe
that ‘controlled-crying’ regimes are necessarily harmful for younger
babies, but there are too many times when they do not go according to
plan and so create stress for the baby and anxiety for the mother.

In general, I find that responding promptly to young babies’ crying as


often as possible in the first six months is the best way while parents
and babies are finding their way. This strategy will eventually get the
same results, often more quickly and with less pain, than trying to
comply with a ‘controlled-crying’ regime (modified or otherwise).

I am not suggesting, however, that it is necessary for the mother to wear


herself out with constant rocking, patting, breastfeeding, wearing the
baby and walking the floor in order to avoid any crying at all. Nor am I
suggesting that every parent has to leave their baby to cry when they
don’t want to. Rather, I believe that allowing a healthy, well-fed baby to
cry at times is a safe option in a loving home if the parents want to give
it a try. Depending on the baby, most parents find that it is impossible
to avoid some crying sessions each day and that there are times when
leaving the baby to cry for a short period may be preferable for some
parents than the other options.

Suggestions for letting a baby cry to settle:


Leave your baby up for half an hour or so after the feed, sitting in a
portable chair or on the floor without her nappy on or keep her next to
you in a front-pack.

After this, give her a top-up if you are breastfeeding then put her to bed.
Wrapping tightly helps many babies to go off to sleep; other soothing
things are white noise or musical CDs, musical boxes or even a dummy
if it helps. If she starts crying, give her five to ten minutes of
comforting—patting or rocking—then leave.

Go back into the room every five to ten minutes depending on the level
of distress of the crying. In between visits get on with whatever needs
doing to take your mind off the crying. If the crying is really upsetting
you, pick her up, calm her down and either put her down again or keep
her with you in the front-pack or in your arms. Try to wait around
twenty minutes before you do this as she may go to sleep.
Some mothers find (in relation to the unsettled period) that when they
let their babies cry on and off for a couple of hours (in between picking
them up and doing some of the other rocking, patting things) then give
them a bath and a good feed their babies go sound asleep and stay
asleep; the unsettled period only lasts two-and-a-half to three hours
instead of the five- or six-hour stint that happens when babies are
constantly walked, rocked, patted and breastfed for hours at a time.

Tolerating some baby crying does develop better sleep patterns for an
appreciable number of babies; however, for some mothers and babies it
creates huge tension and makes things worse. Never do anything that
doesn’t feel right for you. Remember there aren’t always solutions to
‘sleep’ especially in the first six months.

When the unsettled period is in the middle of the night ...


It’s not easy. Letting babies cry in the middle of the night is usually quite
an unrealistic suggestion and not particularly useful when they are under
six months old, so you stay up and walk the floor, or rock and pat your
baby to sleep in her bed. Going back to bed and taking your baby with you
is, sadly, no longer something I can recommend as there are now serious
safety issues to consider. Please read the section on safe sleeping in
chapter 11. When you are up a lot at night you have to try to catch up on
sleep in the day and I know this is difficult, especially if there are other
children, but at this stage of your baby’s life it is easier to change your
sleep habits than to try to change hers.

Catnappers
A number of babies never sleep soundly for three to four hours at a time.
After twenty minutes they stretch luxuriously and become instantly alert as
if waking from eight hours’ sleep! Many babies can be taught to sleep
through the night after six months, but I have never found a way to ‘make’
babies who don’t sleep much in the day sleep more or longer. If your baby
catnaps and is otherwise reasonably content and feeding well it’s best to
accept the fact that her daytime sleeps will be short and frequent rather
than longer and fewer. Trying to resettle babies who catnap after they
wake is difficult and needs a lot of persistence as well as being able to
tolerate a fair amount of crying, with every likelihood nothing is going to
change. Most mothers decide it’s a pointless exercise. Babies who catnap
often sleep well at night.

Day sleeper, night waker


Quite a few babies sleep very well in the day and wake every couple of
hours through the night. If your baby does this in the early weeks there’s a
good chance she may reverse the pattern herself by the time she is a month
or so old. It’s usually worth waking babies for feeds every three-and-a-half
to four hours during the day from about three weeks of age rather than
letting them sleep six hours. This will help them to start to learn the
difference between night and day.

Bad days
Everyone has bad days with babies and toddlers. Bad days happen when a
chain of events leads to everything in the day going from bad to worse
with a nightmarish quality descending by evening. The first bad day you
have with your baby will come as a shock, particularly if things have been
running smoothly until now. Your baby may sleep lightly, wake early, feed
poorly and cry a lot no matter what you do.

What do you do? Don’t panic—a bad day is exhausting and stressful but
rarely a sign of anything major.

If you feel you need to, ask someone you trust (child and family health
nurse, family doctor) to check your baby to make sure she is well. A
vigorous baby with good colour and six to eight pale, wet nappies is likely
to be just fine despite the fussing and crying.

During the day get out of the house with your baby if possible. Staying at
home and listening to the crying makes everything seem worse. Even
sitting in the waiting room of your doctor or child and family health nurse
can make things seem better. Alternatively, reassurance from a
sympathetic friend or your mother helps a lot, especially if they are able to
take over for a while.

Bad days always end eventually. Everyone has at least one in the first few
weeks and several in the first three months.
The sudden, major crying episodes
A sudden crying episode which appears to come out of the blue for no
apparent reason is quite common in healthy babies at any time in the first
year but is more likely to happen in between two and six months. The baby
is quite happy one minute and inconsolable the next and it is often difficult
to calm her.

What can you do? Stay as calm as you can. The more agitated you get,
the more your baby will cry. Sudden crying episodes last up to four hours
and all you can really do is see it out. A bath helps. Often after a bath and a
feed, sleep will descend.

If your baby is otherwise well and it doesn’t keep happening or go on for


lengthy periods (more than four or five hours) a sudden crying episode is
usually not a sign of anything significant. If in doubt, see your family
doctor.

The six weeks change (sounds like the menopause)


Some babies, whether breast or bottle fed, go through a change around six
to eight weeks where they are more wakeful (therefore cry more) and want
to feed all the time. When this happens it may last about two to three
weeks. This is often referred to as a ‘growth spurt’ and while such an
explanation is certainly reassuring I’m not at all convinced that it is the
reason for babies’ behaviour around this time. Other researchers feel it has
to do with a big leap in the baby’s mental development, enabling her to
learn a new set of skills that changes the way she perceives the world,
causing confusion and bewilderment.

Whatever the reason, an unsettled few weeks is certainly observable in an


appreciable number of healthy, well-fed babies around this time. Like a lot
of things to do with babies, it’s unclear because the baby can’t tell us and
all we can do is hazard a guess. If your baby changes around this time,
remember it’s normal and temporary. Give extra feeds and cuddles until it
passes.

Night waking under six months


Most babies wake at least once in the night, cry and won’t go back to sleep
without attention. Generally, this is something that is better to accept than
try to change when your baby is under six months of age.

As previously mentioned, ‘sleeping through’ really refers to the stage


when babies start to put themselves back to sleep in the night without
waking their parents. The age at which they do this varies tremendously
and because this is a common topic of conversation between families,
mothers often think something is wrong when their babies are still waking
at night.

It’s important to remember your baby’s waking habits at night have


nothing to do with your ability as a mother or your baby’s development.
‘Sleeping through’ is not a developmental milestone like walking, sitting,
smiling and so on.

Night sleeping and waking variations


Baby takes a late evening feed (between 8 pm and 11 pm) and an early
morning feed (1 am to 4 am). Roughly 60 per cent of babies stop
waking for one of these feeds between six and twelve weeks.

Some babies continue to wake and need attention once a night (between
1 am and 4 am) indefinitely.

Other babies need no attention for eight hours or longer from as young
as eight weeks then suddenly start calling for room service again once
or twice a night at about four months.

About 20 to 30 per cent of babies continue to wake and cry every three
to four hours through the night, indefinitely.

For reasons that are not clear some babies do sleep between eight and
twelve hours permanently from about six to eight weeks of age. Great
though this is, it can also be a dilemma for women who are breastfeeding,
especially in the first eight weeks:

Some suggestions if your baby is sleeping more than five or six


hours at night
If she is thriving the general rule is ‘never wake a sleeping baby’. There
are, however, some provisos:

If your baby sleeps through some nights and not others you are likely to
find your breasts waking you even if your baby doesn’t. You will
probably find you will have to express. As mastitis is a risk you will
need to take off as much milk as you need to for comfort. If the night
sleeping becomes permanent your breasts will adjust and you will not
need to express in the night.

Most breastfed babies still need six feeds every twenty-four hours to
keep the milk supply going so you will need to make sure that your
baby still gets six (or more) feeds in the twenty-four-hour period, which
might mean some two-hourly feeds during the day and/or evening.
Having said that I acknowledge that some breastfed babies do thrive on
five feeds for indefinite periods. This is the exception rather than the
rule; if you are concerned a quick weigh will give you an idea of what’s
happening.

Night waking—Can anything be done to encourage babies


under six months to ‘sleep through’?
You will find advice abounds on methods and strategies to ‘get’ babies to
start sleeping through the night.

Here are the usual things parents are urged to try:

Wake baby at 10 pm or 11 pm to avoid her waking for the the 2


am, 3 am feed (often referred to as the roll-over or dream feed).

It’s worth a try, but the results are extremely variable. For example,
some babies are difficult to wake, don’t feed properly and still wake at
3 am. Others wake quite happily, feed well then stay awake for the next
two hours! A few wake happily, feed well, go back to sleep and still
wake at 3 am. Many parents I talk to find this strategy makes things
worse, not better, so don’t persist if you find this is the case. Instead, try
to go to bed earlier—at least a few evenings a week.

Replacing feeding with rocking, patting and dummies.


Babies under six months can’t really be ‘trained’ to sleep longer, so this
strategy usually means everyone gets less sleep. Occasionally popping
the dummy in instead of feeding may bring instant, sustained sleep, but
chances are you’ll be up and down all night replacing the dummy.

A feed is usually the best way to settle babies at night when they are
under six months, so don’t hesitate to feed, or start feeding again at
night if necessary.

Giving extra food.

It is often suggested giving extra food in the day or the evening helps
babies stop waking at night. Sometimes this appears to do the trick but
the relationship between food and babies’ night waking is extremely
unpredictable. If you wish to try food from a spoon as a way to
encourage undisturbed nights, wait until your baby is at least four
months old and try not to see it as the magic answer, as 90 per cent of
the time it isn’t.

Starting one bottle of formula as a top-up in the evening to improve the


nights does work sometimes when you’re breastfeeding, for an
unfathomable reason, even when there is obviously plenty of
breastmilk. Nutritionally it’s not necessary for your baby when you
have plenty of breastmilk, so whether to try it or not is up to you.

Generally speaking, giving extra food, whether it’s formula or food


from a spoon, is not going to make any difference unless the baby is not
getting enough to eat and is hungry, and even then it may not change
anything. I see many instances where an underfed breastfed baby who
‘sleeps all night’ starts waking again when given more food.

When your baby is still waking a lot at night after six months, strategies
can change if it is a problem for you. See chapter 28.

Routines and spoiling


It’s unfortunate the word ‘spoil’ is still used when we talk about babies
and how to look after them. Spoiling is a negative word which suggests a
spoilt baby will grow into an unpleasant child no one likes.

When parents are worried about spoiling their baby it implies babies can
deliberately make parents do what they want them to do by acting in
certain ways. Conflicting advice from lots of people who are all sure they
are right makes it difficult for a new mother to know whether she is
‘spoiling’ her baby or not—and if she is, does it matter?

The term ‘spoiling’ shouldn’t be used when we talk about babies,


especially in their first year. A baby is too young to try to make her parents
behave in a certain way by thinking through the results of her actions; for
example, ‘If I cry a lot they’ll pick me up’.

Living with the way a young baby eats, sleeps and cries is one of the
hardest things parents have to learn to adapt to. Some babies obligingly
fall into a regular eating pattern and learn to sleep on their own very
quickly. It is often assumed these are ‘good’ babies with efficient mothers
but in fact these babies just happen to adjust to our way of life a little faster
than others. This does not make them grow up into better people.

The ‘eat and sleep’ babies whose parents proclaim proudly ‘we don’t even
know we’ve got her’ are in the minority, and parents who go on like this
are usually exaggerating—it doesn’t matter how much a baby sleeps, trust
me, we all know we’ve got them. Perpetuating the myth that this is how
babies are meant to be causes new mothers a great deal of anxiety.

Generally, working out how best to meet a baby’s needs either by trying to
organise a routine or simply not bothering is one of the trickiest and,
increasingly, along with ‘sleep’, one of the most polarised areas of
babycare.

I’m intrigued to see the resurgence of information harking back to the


‘strict routine from birth’ philosophy that was all the go for most of last
century. I believe this is in part a response to the push of the eighties and
nineties to do away with routines and go for ‘instinctual’ or ‘natural’ style
babycare. The strict routine style is very appealing to mothers who want to
be able to structure and plan their days and live and function in a
predictable and organised way. There’s also the promise built in to these
regimes of getting babies to sleep through the night as early as seven or
eight weeks. I sympathise with this but I don’t offer such routines, as in
my experience there are too many times when they caused havoc. When
these strategies work I think it’s usually because the baby obligingly goes
along with the idea. And if this happens with a minimum of distress and
crying, fine. There’s also the potential for strict routines to mess up the
breastfeeding—although again, some women’s breastfeeding works well
no matter what.

The ‘instinctual’ or ‘natural’ style of babycare is appealing to mothers who


feel it is more harmonious and close. They are happiest doing their own
thing in their own relaxed way and if there’s a muddle in the house, so be
it. This style of babycare can be taken to extremes where the baby is never
put down or separated from her mother at any time. Again, if the mother
(and father) is happy about this, it’s fine; however, some women who start
out like this with the best intentions find they can’t handle it and collapse
under the strain in a heap of guilt.

I believe that mostly mothers do what they’ve always done—a bit of both.
Overall, trying to make a baby behave in a certain way by imposing a set
of rules on her before she has developed any control over her behaviour
and by trying to eradicate normal baby behaviours and needs—for
example, night feeds at a young age—has the potential to make life
unnecessarily miserable for the baby and her family.

On the other hand, trying to live up to the ideals of what is known as


attachment, natural or instinctive parenting can also take its own toll.

I am aware that some readers of Baby Love are disappointed because I


don’t include charts of routines to follow or make any concrete
suggestions about getting young babies to sleep through the night. I am
also aware of the disapproval of others because of my suggestions to leave
babies to cry for short periods and the use of ‘controlled-crying’ in the
second six months. So be it.

A reflection of the work I did for so many years helping a diverse range of
parents in a diverse range of situations.

A summary of my approach to routines


During the first six months of a baby’s life a routine is more for adult
convenience rather than something that is essential for a baby’s
wellbeing.
A baby’s instinct is to be held and breastfed more or less continuously.
It does not come naturally to babies to be fed large amounts less often
and put somewhere on their own to sleep, which is what fits in best
with our very structured way of life. In many cultures babies are given
the breast constantly while permanently attached to their mothers. This
probably avoids a lot of the hassles mothers go through in our culture
trying to work out how to ‘make’ babies cry less and sleep longer, but
is not a practical approach for life with a baby as most of us live it.
Patience and flexibility is needed while our babies learn to fit in with
our way of life.

This being the case, it’s much better, if you can, to take a reasonably
relaxed approach and try not to get yourself in a knot about four-hourly
feeding and sleeping regimes, especially during the first three months.
Between six and nine months everything becomes much more
predictable and it’s easier to follow a more structured routine. By the
time babies are toddlers, routines are important for safety and a sane
family life.

During the first six months it may seem at times that the days and
nights with your baby are chaotic, but you will find as the months go by
a pattern emerges which tends to become more consistent in the second
six months.

If a routine is important to you, it is much easier to gradually structure


eating, sleeping and waking cycles over a reasonable period of time.
When possible stick to a consistent way of doing things even when your
baby doesn’t sleep much.

On the other hand, if routine doesn’t matter at all to you just do what
you feel comfortable with.

All babies and families are different. Babies thrive just as well in
families where they are guided into a flexible routine as they do where
there is no routine at all—as long as their homes are safe, stable and
loving.

And despite what I said about routine charts, below is a very simple one as
a guide.
Guidelines for a feed–up–sleep daytime pattern, birth to six months
N.B.: This is a guide only. It will not suit all mothers and babies. You may not always be
successful in helping your baby to sleep; however, it is a good idea to always try to put her to
sleep an hour or two after her feed or when she shows signs that she is tired.

Feed your baby (feeding time usually decreases as the baby grows, whether breast or bottle
fed).

Let her stay up for one to two hours (depending on the age—usually as they get older babies
are happy to stay up for longer).When she starts to get grizzly and her movements get jerky,
put her to bed and settle for sleep, trying any of the options to settle suggested in chapter 14.

Hopefully she will go to sleep and stay asleep for one and a half to two hours.

Feed again when she wakes, or if she wakes in half an hour and you can’t resettle, see if you
can delay the feed for at least two and a half hours from the beginning of the last feed.

Some ideas for ‘up’ time:

A bath.

Go for a walk.

Pop around and see your mother, mother-in-law, friend, lover or child and family health nurse.

Prop her up in the shade outside or inside near a window where she can see the wind blowing
the leaves on a tree.

Sit her in a portable chair where she can see what’s going on.

Let her lie on the floor on towels without a nappy on.

She may like just lying in her cot looking at her mobile for a while.

Hold her so she can see your face, your eyes and feel your touch.

Read her a story.

Summary of sleeping and waking: 0–


6 months
There are ways of encouraging babies to sleep, but remember there are no
guaranteed solutions all of the time to the problems of crying and sleeping,
so don’t feel inadequate when you can’t help your baby to sleep; baby
experts don’t know the answers a lot of the time either.
Generally if whatever you are doing (letting cry, rocking and patting,
pushing in the stroller) is going to work to get your baby off to sleep, it
will do so in about twenty minutes. If your baby doesn’t settle within
twenty minutes she’s probably not going to at this time. It’s probably best
to keep her up and try again after her next feed when hopefully she will
sleep.

There are times in the early weeks when parents may have to change their
routines (mother sleeps in the day, father cooks the dinner and maybe
sleeps in another room for a while) as at this time it is impossible to
change the baby’s routine.

Here are some helping-to-sleep tips


Abolish the words ‘good’, ‘bad’ and ‘spoil’ from your baby vocabulary
and encourage those around you to do the same.

Look for options rather than solutions.

Make sure your baby is not hungry. Hunger does not play a major role
in wakeful babies but if you’re breastfeeding a quick check of your
baby’s weight tells you if there’s enough milk; a one-off clothed weight
at your child and family health centre or pharmacy is sufficient. Little
or no weight gain over several weeks is an indication she might be
hungry. If you’re bottle feeding, make sure you’re making the formula
up the way it’s supposed to be made.

Is your baby ready for sleep? From three weeks on, babies start to have
regular times when they are happy to be awake. This time increases as
they grow older. When they are ready for sleep they start to cry or grunt
and suck their fists. Their movements become jerky and they lose eye-
contact.

Babies sleep better on a firm mattress. Dense latex such as maternity


hospitals use is fine. There are no particular baby mattresses that are
more advantageous than others in relation to SUDI as long as the
mattress is firm and well-fitting.

The following things are options, all of which work some of the time.
Remember that when they work (that is, the baby goes off to sleep,
hopefully a sustained sleep for an hour or two) they tend to work within
about twenty minutes. Some of them are unacceptable to some families,
some of them are not possible because of family lifestyle and some may
lead to hassles later, but they are all safe:

Breastfeed your baby to sleep;

Rock and pat your baby to sleep;

Sleep with your baby (bearing in mind safe sleep recommendations);

Try wrapping your baby firmly so she can’t wake herself up when
she startles;

Carry her in a sling;

Give her a warm bath;

Play some soothing music;

Go for a walk;

Give her a dummy.

Unfortunately, if babies only ever learn to associate sleep with these things
it often means they don’t know how to sleep unless they are present. For
example—when a baby goes to sleep on the breast or in her mother’s arms
she will often wake again soon after being put into her cot and it is very
difficult to help her back to sleep. Once she is up again she gets tired very
quickly, starts to cry, goes to the breast again, falls asleep, is put into her
cot only to wake again a short time later when the cycle is repeated. The
reason this happens is because the baby goes to sleep under one set of
conditions and when she wakes briefly, as she passes from one sleep stage
to the next, is immediately aware her environment is different so comes
fully awake and starts to cry instead of slipping into the next stage of
sleep.

As time goes by mothers find it more and more difficult to carry out these
routines. So another option is to put your baby down awake and let her cry
to sleep sometimes. Like all the other options, sometimes this works and
sometimes it doesn’t, but letting a well-fed tired baby cry before sleeping
can be an aid in helping her to learn how to sleep. Try leaving her for up to
twenty minutes some time during the day or the evening, following the
guidelines earlier in this chapter.

FOR MORE INFORMATION


Chapter 5: Choosing Baby Products (dummies)

Chapter 11: Daily Care (where to sleep)

Chapter 12: Safety (dummies)

Chapter 19: Common Worries and Queries (thumb-sucking)

Chapter 28: Sleeping and Waking Six Months and Beyond (teaching to sleep)
15

The Crying Baby


Previous chapter | Contents | Next chapter
Why do babies cry?

All babies cry. You may find listening to your baby cry is one of the
hardest parts of being a parent. From your baby’s point of view, crying is
an essential part of her survival and not something she does to irritate or
upset you.

Baby crying, a vital way of communicating, has ensured the survival of the
human race. It is the most obvious form of early communication but not
the only one. Young babies send out communication in other more subtle
ways. They gaze intently at an adult face, coo, smile, grasp a finger and
indicate when they don’t want food by not sucking or pulling away.
Mothers respond to all these things and take great pleasure in many of
them. Crying, however, is the most powerful way babies have of
communicating when they are very young and to some extent during the
whole of their first year.

Parents are often unprepared for the crying, believing that as caring people
who are only too happy to do the right thing and meet all their baby’s
needs their baby will not cry. They find it shattering to discover that a
certain amount of crying is normal for all babies and for some babies that
amount is a lot.

Parents, understandably, start to think it would be much easier if their


baby’s main way of communicating was not by crying, but crying is the
main way babies have of letting their protector know they need something.

A lot of the time what they need is obvious and easy to provide. Obvious
causes of crying are things like hunger, over-tiredness, thirst, feeling too
hot or too cold, loneliness, over-stimulation, being undressed and bathed,
or being alarmed by a sudden noise.

Babies also cry when they are in physical pain. An accident, an injection
or a circumcision are clear-cut reasons for distress we can all understand.
Medical problems such as an inguinal hernia or a bowel obstruction are
other painful experiences. It’s very upsetting when a baby gets sick but,
once diagnosed, the problem can be treated; knowing something can be
done always brings a sense of relief.

When there is no obvious cause, mothers, fathers and even health workers
feel helpless, hopeless and distressed, especially when the crying goes on
for a long time. I’m sure the baby feels pretty miserable too.

Patterns of crying
The age and times of day babies cry tend to fall into identifiable patterns.
This doesn’t mean this applies to every single baby, nevertheless having an
idea what is common can be helpful.

From birth to three weeks many babies sleep a lot, the crying periods don’t
last long and are easy to resolve.

From three weeks onwards things may change, sometimes dramatically.


Babies tend to cry more and sleep less. The crying, unsettled behaviour
can roughly be divided into three groups:

Explained crying is expected crying and the cause is obvious. It is easy


to do something which calms and settles the baby such as feeding,
changing or gently rocking. Sometimes a bath, a walk or, if it’s in the
middle of the night, taking the baby to bed is what’s needed.

Unexplained crying is unexpected crying for a reason which is hard to


find. Unexplained crying for a short period every twenty-four hours is
normal for about 80 per cent of all babies.

A small number of babies (about 20 per cent) cry a lot for large parts of
the day and night, so instead of having one session of crying they have
several which go on for a long time. These babies sleep poorly, wake
early, cry and draw up their legs a lot. Days stretch into weeks and into
months, with no change. There are bad days and worse days, rarely any
good days, until things slowly start to change between three and six
months. This sort of crying in healthy, loved, protected babies remains
to a large extent a mystery and is what this chapter of the book is about.

Searching the web and the shelves of bookstores you are bound to find a
myriad of sites, blogs articles and books offering the definitive reasons,
cures and ways to help babies who cry a lot. Some of this information is
based on research, some on the experience of practitioners in the field,
some on personal experience, some on opinion and some on touchy-feely
snake-oil. I can only add my point of view to what’s already circulating.
My information is based on research and years of hands-on experience
with families and babies. Like all information related to crying babies, my
approach will help some and not others. I do tend to write more about what
doesn’t work rather than what does, because despite the constant flow of
literature and research for the last one hundred years, no causes or
treatments have been identified that have made any significant difference
to helping crying babies who appear to be otherwise healthy. Ideas change,
new theories replace old, but the babies keep crying.

If your baby cries a lot it is important to be aware that:

The majority of crying babies are healthy babies who do not have
clearly defined, treatable medical problems.

There is not an easy, single answer that suits every baby who cries
excessively.

Crying babies invariably grow into delightful older babies and toddlers.

This period of your baby’s life is something you have to go through


together. Practical help, support and understanding helps a great deal;
beyond a certain point, parents are on their own.

I hope the following chapter contributes to your understanding of these


babies and helps you and your baby through the crying.
How does excessive crying affect the
family?
Even though in the sum total of a baby’s whole life this is a tiny part,
living with a baby who cries excessively can have a profound effect on the
parents, their relationship and family life. Most people are astounded at
how much time any baby takes up even when things are going well. If the
baby spends a large amount of time every day crying and unhappy and
apparently not responding to all the love and attention she is getting, the
mother becomes physically and mentally exhausted.

Mental exhaustion
Feelings of guilt, loss of confidence and loss of self-esteem may come
from within or may be triggered off by health professionals, partners,
grandparents or the neighbour. Women whose babies cry a lot often
become isolated simply because even if they can accept the crying, others
can’t.

A mother with a crying baby may feel disappointed when a much-loved


beautiful baby doesn’t come up to everyone’s expectations—‘not a good
baby’. Disappointment might turn to anger as the mother tries harder and
harder and becomes more and more exhausted.

This is a pretty grim picture and of course not everyone experiences all of
these feelings all of the time, but it is quite normal for a mother in this
situation at times to wish she had never had the baby and for both parents
to see life before the baby as quite pleasant.

Physical exhaustion
Women find so much time in the day is spent with the baby there is little
left for anything else and the house becomes chaotic. Well-meaning
advisers tell mothers to ‘forget about the housework’, knowing they
themselves would find it stressful living in a mess. It would be more useful
to offer practical help.

A constantly crying baby causes a physical response in some women.


Chest pain, sweating, palpitations, nausea or light-headedness are all
common. Add to this sleep deprivation and often an inadequate diet—is it
any wonder women working under these conditions are in a state of
physical exhaustion!

Relationships
Relationships are certainly tested in ways they never were before the baby
arrived. Sex and social life tend to become non-existent. Couples who
previously lived in harmony argue over the best way to look after the baby
(pick up, let cry, share the bed, separate room, medicate, don’t medicate,
stop breastfeeding, keep breastfeeding, change the formula and so on and
so on).

Some fathers blame the mother, some ignore the mother’s distress and feel
sorry for the baby. Others become helpless and hopeless, insisting on their
right to sleep, so the mother starts to feel she is dealing with two crying
babies, not one.

Another man might want to share the responsibility and give as much
support and comfort as he can, only to find the mother shuts herself and
the baby off from him. He starts to feel useless and switches off.

Constant crying is doubly difficult when there is no one to share feelings


or help decide the best options. Single parents with no one often find they
end up using medication or leaving the baby to cry, even when they don’t
want to do this. There just seems to be no other solution.

A constantly crying baby is likely to give any relationship, good or bad,


somewhat of a battering. In general, good relationships stay good after a
baby arrives and bad ones tend to get worse—the baby only emphasises
how good or bad the relationship is. This is magnified for the 20 per cent
of parents who have a baby who cries a lot in the first three to six months;
however, many relationships emerge stronger and a new bond forms
between the couple.

What can be done?


1. Rule out hunger and feeding problems. Very few crying babies cry
because they are hungry; the reason for the crying is rarely that simple,
but it is important to make sure. If your baby is crying a lot and you are
breastfeeding, weighing the baby is the most reliable way of checking
the likelihood of hunger. A one-off clothed weight at your child and
family health centre or your doctor’s is sufficient. Little or no weight
gain over several weeks is an indication she might be hungry. If
weighing reveals hunger is the cause of the crying, giving extra food
will help your baby to be more settled.

2. Breastfeeding

Check your baby is in the best position to feed well. Worrying,


unexplained crying in a healthy breastfed baby who is gaining
weight well is rarely a breastfeeding problem.

It is suggested by some breastfeeding researchers that excessive


crying in breastfed babies may occur because the baby is getting too
much foremilk and not enough hindmilk. As foremilk has relatively
high levels of lactose (the sugar found in milk) and low levels of fat
compared to hindmilk one of the many theories about crying
breastfed babies, is that too much foremilk and not enough hindmilk
may upset their guts and not satisfy their hunger. The standard
advice for what is known as foremilk/hindmilk imbalance, especially
if the mother is feeding for relatively short times at each breast, is to
leave the baby on the first breast until the baby spontaneously comes
off before offering the second breast.

This is worth a try but note that other research shows it is not
possible for babies to consistently consume only ‘low-fat foremilk’.
I have not found that this advice makes any enduring difference to a
crying baby’s behaviour, rather it has a tendency to raise
unnecessary doubts in the mother’s mind about her ability to
breastfeed and the quality of her milk at a time when that’s the last
thing she needs.

Excessive crying happens equally to breastfed and bottle fed babies,


so weaning does not mean the crying stops. Some women manage
better by weaning, but think everything through carefully before you
take this step if breastfeeding means a lot to you.
3. Bottle feeding

When bottle feeding, make sure you are making the formula the way
it’s supposed to be made. When babies are crying a lot it’s always
tempting to keep changing the bottle, the teat and the brand and type
of formula, but this rarely makes any lasting difference. In general
it’s best to stick to a cow’s milk-based formula labelled ‘suitable
from birth’.

4. If you are concerned about your baby’s health, have her checked by a
paediatrician to rule out the possibility of a clearly defined medical
condition. Persistent crying occasionally does have an obvious
underlying medical cause which is possible to diagnose accurately
without subjecting the baby to a round of invasive diagnostic
procedures. When this is the case, the medical cause can be successfully
treated, which brings an end to a lot of the crying.

Main medical causes


Inguinal hernia
A hernia in the groin can become clamped off by the tight muscles in the
groin. This is called strangulation, causes intense pain and should be
operated on as soon as possible. A similar thing can happen to baby boys
who have an undescended testis, although this is rare.

Note, a squashy lump on the navel which ‘pops’ out when the baby cries is
an umbilical hernia. Umbilical hernias are very common, rarely cause pain
and are unlikely to be the cause of constant crying.

Intestinal obstruction
When a baby cries a lot, parents are often worried that ‘something is
twisted inside’ because their baby goes red and draws up her legs when
she cries (see here for an explanation about this). Several medical
conditions can cause intestinal obstructions in babies but:
They are very rare;

Babies born with these conditions are nearly always diagnosed soon
after birth;

The other main type of intestinal obstruction (intussusception) is more


likely to occur between three and twelve months and is usually a clear-
cut diagnosis;

Crying due to intestinal obstruction is accompanied by weight loss,


pallor, a sudden change in the baby’s poo and an alarming change in the
baby’s behaviour. Going red, grunting a lot and drawing up their legs is
normal behaviour for most babies and not a sign of pain.

Urinary tract infection


A small number of crying babies do turn out to have urinary tract
infections which, once treated, makes the baby much happier, so testing of
a crying baby’s urine is routine. Other signs apart from the crying might be
‘thick’, smelly urine with obvious discomfort when the urine is being
passed by a very irritable baby who might also have a fever.

Physical or mental disability


Most of these problems are diagnosed at birth or soon after. Unfortunately
some are less obvious and it may be many months before parents know
exactly what is wrong.

For example: cerebral palsy—minor degrees of cerebral palsy are difficult


to diagnose and can cause tense, crying babies; deafness can cause crying,
unsettled babies; undiagnosed heart conditions can also be a cause of
miserable, irritable babies who are often difficult feeders who gain weight
poorly.

All these things are rare and unlikely to be the cause of your baby’s crying,
but because they do exist and are sometimes overlooked, make sure your
baby is checked by a paediatrician or a doctor.

Common infections
Illnesses such as head colds, viral diarrhoea, bronchiolitis, sore throats or
ear infections are either obvious causes or easily diagnosed and can all
contribute to a cross, crying baby. When the baby recovers, the crying
behaviour settles, whereas the healthy, crying baby cries on.

Viral diarrhoea, sore throats and ear infections are a much more common
cause of ‘explained’ crying in older babies and toddlers and are not seen
very often in babies under three months of age.

The following things do NOT cause persistent,


unexplained crying in healthy babies
‘Teething’; cradle cap, heat rash or hormone rash; frothy or loose poo in a
healthy breastfed baby; constipation in a bottle fed baby; thrush; nappy
rash.

Having ruled out hunger and the possibility of an underlying illness, there
remain the myriad theories and unproved diagnoses with their
accompanying treatments that parents quickly become familiar with as
they try to find an answer. Writing about every theory and suggested cause
is a book in itself, so I will look at the major themes in use at the current
time to explain and/or ‘treat’ crying babies under two groups—medical
and non-medical.

Medical approach
Unlike the previous medical conditions, these medical conditions are not
clear-cut, so the treatment may not be wildly successful. The majority of
babies who are treated for the following conditions probably haven’t got
what it is they are being treated for.

Apart from finding the few babies who have the diagnosed condition and
so benefit from the treatment, the other advantages of the medical
approach are:

It helps the mother to feel better and stop blaming herself for her baby’s
distress.
Medication often has a valuable placebo effect. A placebo effect refers
to a positive result achieved by a non-medical remedy or a harmless
medical remedy prescribed for a non-existent condition. The placebo
effect should never be ridiculed because no one knows for sure why
some babies cry so much in the first three to six months. If harmless
remedies and simple diagnoses help parents through a critical period the
placebo effect should be encouraged. By understanding that a placebo
effect exists, parents are also more aware of the limitations of
medications and remedies.

It gives the mother a concrete plan of action instead of vague


reassurances.

The medical approach also has disadvantages:

It can give parents unrealistic expectations of results.

A medical diagnosis not properly explained is very worrying for some


parents—they may think their baby has a serious long-term illness
which is unlikely to be the case.

Searching for a medical cause can start a merry-go-round of medication


and feeding changes which in themselves start to cause problems so it
becomes more and more difficult to work out what is going on.

A medical diagnosis often precipitates unnecessary weaning for


breastfed babies.

Occasionally the medication suggested is unsafe.

The main medically based theories as to why babies cry a lot are all
centred around the baby’s gastrointestinal tract (the gut).

They are as follows:

colic/wind

allergy/food intolerance

reflux
lactose intolerance

The persistent belief that healthy babies who cry a lot have gut problems
has been shown over and over again by observation and research to be
incorrect most of the time. Despite this, health professionals, who agree
it’s highly unlikely to be the cause of the baby’s distress, continue to
diagnose and treat something they themselves think is non-existent most of
the time.

Why? Partly because of the baby’s and parents’ distress when there is no
explanation, partly because of the time factor (it’s quicker to diagnose and
medicate than spend a lot of time counselling and comforting) and partly
because medication is easily available whereas practical help and
resources to help distressed families aren’t.

A diagnosis of a problem in the gut is nearly always based on the way the
baby behaves, not on medically proven symptoms. All babies go red in the
face and draw up their legs at times when they cry. This is an automatic
reflex which can be observed in all babies whether they cry excessively or
not. It is usually because they are generally distressed, not because they
have pains in their bellies. Similarly, an adult stamping his or her foot
when upset does not mean he or she has a pain in the foot. The longer
babies cry and the less sleep they have, the more distressed they become
and the more they repeat this action. Adults quite inappropriately project
their own intentions or reasons for actions or behaviour onto babies and so
confuse this with adult behaviour which would indicate a pain in the gut.
These medically based theories started from this premise.

Colic/wind
Colic and wind are the most frustrating of all the medically based theories
as they really are an inaccurate way of describing what the baby does
rather than what the baby has. Parents, however, are led to believe that the
word ‘colic’ is a diagnosis of a medically proven condition and so
conclude treatment and a cure are just around the corner.

Colic is a general term which means acute paroxysmal pain. Nowhere else
in medicine do we use the word ‘colic’ without describing the site of the
pain—example, renal colic, biliary colic or menstrual colic. Calling
excessive crying in a healthy baby ‘colic’ implies a severe pain in the
stomach or bowel similar to that experienced by an adult who eats a bad
oyster or who has a bowel obstruction. This doesn’t make sense when we
are referring to a normal baby who is having the correct food. The word
‘colic’ as a diagnosis for a baby’s crying really means ‘This healthy baby
is crying a lot and we don’t know why’.

The myths surrounding babies and ‘wind’ are second only to that of
‘teething’.

Burping and passing wind are normal functions of the human body from
birth to death and all babies fart very loudly and very well from the
moment they arrive. Some babies do appear to show discomfort associated
with eating, digesting and pooing by responding to these normal body
functions by squirming, grunting, going red in the face and sometimes
crying. I believe this is more a psychological response to the new sensation
of all these things happening to their bodies, not physical pain or
discomfort the way adults understand it. When babies are generally
distressed, overwhelmed and over-tired they are much more sensitive to
these internal body movements and exhausted parents looking for answers
tend to see these responses as the cause of their baby’s crying.

Helping your baby to burp when she is wriggling, squirming and unsettled
by holding her over your shoulder or lying her across your lap and
applying some pressure to her back may relieve her distress sometimes,
but overall ‘burping’ techniques make very little difference to the
behaviour of crying babies.

Gastro-oesophageal reflux disease (GORD): otherwise


known as reflux
Reflux is such a common word used in baby circles that most mothers are
aware of it.

What is meant by the term gastro-oesophageal reflux


disease (GORD)?
It is normal in humans of all ages for food from the stomach to flow back
up into the gullet, especially after meals. This back-flow is called ‘reflux’.
The technical names of the stomach and gullet are gastro and oesophagus,
hence the term gastro-oesophageal reflux is used to describe this action. In
childhood and adulthood we are unaware of it unless it causes heartburn or
other problems (nasty taste in the mouth, sore throats, coughing, sleepless
nights and so on).

The reason the food-flow goes up and down unnoticed in adults and
children is because the gullet is large enough to hold the churned-up food
from the stomach and because the muscle, known as the oesophageal
sphincter, at the top opening of the stomach works efficiently to keep the
food down where it’s supposed to be.

Poor co-ordination of the movement of food between the oesophagus and


the stomach also contributes to reflux problems in babies. It’s still not
clearly understood why some babies never regurgitate, some regurgitate all
the time and are happy, others regurgitate and scream and are miserable.
None of the variations has anything to do with the mother’s care of her
baby.

It’s confusing then to use the word ‘reflux’ to describe a medical condition
in a baby without specifying exactly what the problem is. As with ‘colic’,
it has become a general term used to describe a miserable baby, often with
no specific symptoms.

When difficulties arise from this reflux action they can be divided into
specific problems.

Constant regurgitation: Almost half of all babies throw up to a degree


that makes parents anxious and complicates normal living. Apart from
the regurgitation the baby is otherwise well, happy and gaining weight.
Unfortunately the constant aroma and mess is never-ending and being
thrown up on all day does little for a mother’s self-esteem.
Regurgitation often increases at around eight to eleven months when
many babies are crawling. They are horizontal to the floor at this time
and heave themselves around leaving multi-coloured puddles as they
go. The regurgitation eventually stops at about a year for all but 5 per
cent. A combination of an upright position and improved functioning of
the muscle between the stomach and the oesophagus helps stop the
flow. For more on regurgitation and vomiting, see chapter 10.

Lung problems: A tiny number of babies who regurgitate a lot draw


some of the stomach contents into their lungs. This causes coughing,
wheezing, breathing difficulties or pneumonia. If these problems keep
happening, medical care is needed by a specialist doctor. Lung
problems due to regurgitation are more common in very premature or
sick babies.

Weight loss: A small number of babies may be reluctant to drink


because of associated pain with heartburn. This is very unusual as
heartburn is uncommon in babies under four months of age and again is
more likely in babies who are premature, sick or developmentally
delayed. These babies develop anorexia, do not thrive and need
specialist attention. However, weight loss related to regurgitation is not
common so other reasons for weight loss should always be investigated
before diagnosing failure to thrive caused by regurgitation. Steady
weight loss in a breastfed baby who is regurgitating is more likely to be
because the milk supply is low than because of the regurgitation.

Limiting a bottle fed baby’s intake to try to stop the regurgitation will also
cause weight loss. Babies who regurgitate a lot but are otherwise happy
should be fed as normal regardless of the regurgitation. Reducing their
intake reduces their weight.

Heartburn (acid reflux): When unsettled, crying babies are diagnosed


as having reflux, the person making the diagnosis usually means the
baby is crying all the time because the stomach contents are irritating
the gullet, causing heartburn. In actual fact heartburn in babies is
uncommon because babies have such bland diets, especially before they
start solids. The condition is very much over-diagnosed and treated.

Occasionally, however, acid reflux is a problem and may be so severe the


gullet becomes ulcerated and bleeds and the baby may vomit blood. Again,
this needs treatment from a specialist doctor.

Diagnosing gastro-oesophageal reflux disease (GORD)


Unfortunately, trying to diagnose GORD in babies is very difficult. Often
the diagnosis is made on behavioural symptoms (that is crying,
wakefulness, breast or bottle refusal, back arching and so on) and there is a
wide range of baby behaviour in the first three to six months which,
although worrying, does not necessarily indicate a medical condition
warranting drug treatment.

Various procedures can be used to diagnose GORD in babies, but none of


them are so definitive that they are appropriate for all crying, unsettled
babies.

Treatment for GORD problems: Simple treatment involves posturing


the baby when she sleeps so she lies uphill and trying to feed her in a
tilted or upright position, which is difficult in the early breastfeeding
days but can be done once the breastfeeding is well established and
there is less chance of nipple damage.

Frequent small feeds are generally better tolerated than large infrequent
feeds when the baby has acid reflux.

Medications are used. See chapter 15.

Very occasionally, surgery is performed. It is only considered when


there is no doubt about the diagnosis and there are continual
complications which put the baby at risk and cannot be solved any other
way. This is more common in babies with other problems, for example
cerebral palsy.

Food allergy and food intolerance


Allergy to protein, which may be cow’s milk or soy milk protein, is a
possibility in 1 to 3 per cent of babies. Research yields very conflicting
results about the incidence of excessive crying being caused by allergy or
food intolerance.

For more information on food allergy and food intolerance see chapter 18.

Here are the usual suggestions:

If the mother is breastfeeding, try avoiding a range of food to


prevent transfer of antigens to the baby.

Babies born with family histories of allergies are 50–80 per cent more
likely to develop allergic diseases compared to those with no family
history (a 20 per cent chance). The risk is higher when both parents are
allergic as opposed to one parent. The risk is also higher if the mother
(compared with the father) has allergic diseases.

If you have a strong family history of allergy (food reactions, hayfever,


asthma, eczema) it may be worthwhile eliminating milk and milk
products from your diet and even, under dietary supervision, try various
elimination diets to eliminate foods which are known to cause adverse
reactions due to food intolerance—wheat and fish and naturally
occurring salicylates, for example.

In rare circumstances babies have a major reaction in response to a food


protein passed through the mother’s breastmilk. This is usually milk
protein but as soy protein can also be problematic, changing from dairy
to soy products is unhelpful and not recommended.

For the majority of breastfeeding women who have very unsettled


crying babies, the stress involved with strict special or elimination diets
is disproportionate to the results achieved. And, in relation to
preventing food allergy in babies, the latest thinking is strongly veering
towards there being no benefit in such strategies, see chapter 18.

The majority of crying babies spontaneously become much more settled


between three and four months regardless of what their mothers eat. I
have found, overall, that meddling with a breastfeeding mother’s diet
tends to be unsuccessful and often adds tension to an already stressful
situation. For more on food allergy and intolerance, see chapter 18.

If the baby is having formula, change the formula

Change of formula occasionally makes the baby happier but the change
is often short-lived.

If there is a strong family history of allergy it has been the practice to


recommend HA formula (hydrolysed formula where the milk protein is
artificially partially broken down; see also chapter 7) in the belief that
HA formula reduces the incidence of atopic eczema and food allergy in
high-risk babies. However, recent studies (2011) at the Murdoch
Childrens Research Institute found that HA formula does not reduce
allergy risk in susceptible babies. For more information, go to
www.mcri.edu.au/news and click on July. Whether HA formula will
calm an otherwise healthy crying, distressed baby remains in the realm
of guesswork. There is no doubt that anecdotal claims are made about
improvements following changes of formula and occasionally the
improvement will be sustained, nevertheless, I find overwhelmingly
that any improvements are likely to be temporary and that occasionally,
changing the formula makes things worse.

Lactose intolerance
What is lactose intolerance?
Lactose is a sugar which only occurs in the milk of mammals, including
humans. Babies of all species produce an enzyme called lactase while they
are receiving milk which helps digest the lactose. Once weaning occurs
lactase is no longer produced in any animals apart from humans.

Not all humans continue to produce lactase. People from Asia,


Mediterranean countries, the Middle East and some indigenous Australians
do not produce lactase after weaning, which means their guts may be
unable to digest the lactose found in dairy products. Caucasian and other
people with a history of consuming dairy products usually keep producing
lactase into adult life.

Types of lactose intolerance

Primary Lactose Intolerance (congenital)


This is an extremely rare deficiency caused when a baby is born without
the ability to make lactase. This is apparent soon after birth. These babies
do not gain weight and are very ill. Some researchers question that the
condition really exists as it has only ever been indentified in a miniscule
number of babies.

Secondary Lactose Intolerance


This occurs following damage to the gut due to gastroenteritis, giardia
infection, coeliac disease, some medications, cow’s milk protein
intolerance, and so on. Lactase production is decreased and wind, nausea
and diarrhoea keep recurring if milk products are given. Breastmilk,
however, is well-tolerated by most babies with secondary lactose
intolerance despite the fact that breastmilk has high levels of lactose. Some
breastfed babies will need a low lactose formula instead of breastmilk (or
sometimes as well as breastmilk, depending on the severity of the gut
damage) for a week or for as long as it takes their guts to recover at which
time full breastfeeding may be resumed.

Secondary lactose intolerance is more common after the first three to four
months as older babies/toddlers are more exposed to all the common
infections once they are moving around, mixing with other babies/toddlers,
and generally out in the big, wide world.

Functional Lactase Deficiency


This is the condition most relevant to healthy crying breastfed babies in the
first three to six months. It occurs in thriving babies who poo like crazy
(watery, frothy poo), often have bright red bottoms, and what appears to be
abdominal pain (tricky, often, to work this out). They are also very
unhappy (screaming) a lot of the time. If breastfed, it is believed that these
babies are receiving more lactose in the breastmilk than they can
comfortably digest. I must emphasise here that a considerable number of
breastfed babies do poo like crazy—and it’s sometimes watery—fart like
mad and have a temporary redness of the bum in the first six to eight
weeks but are not unhappy and (mostly) sleep well between feeds. This is
not about those babies. It is about the babies with these symptoms who are
also very unhappy day in and day out over a much longer period.

The recommended course of action (if breastfeeding)


Allow the baby to come off the first breast spontaneously before
offering the second breast.

Space feeds, if possible—allow three hours between feeds. Offer the


least full breast in between if you have to feed before the three hours
are up.

Check that the baby’s position and attachment at the breast are correct
to allow for optimum drainage.

This is thought to maximise the fat content and allow more time for
digestion of the lactose. It’s worth a try.

And formula-fed babies?


If using formula, a change to a low lactose formula may be advised.

TO SUMMARISE
Like other strategies used to try to help healthy, unsettled babies,
diagnosing and treating babies for lactose intolerance is mostly
guesswork on the part of the person making the diagnosis and usually
makes very little difference to how the baby behaves. It is particularly
upsetting for mothers to be told to wean and use formula because of
‘lactose intolerance’.

There is no evidence supporting the use of lactase drops.

Despite research to the contrary and my reluctance to suggest this


course of action I am aware that a small number of breastfeeding
mothers—at the desperate stage—find that weaning or partially
weaning and putting their babies onto a low lactose formula has
positive effects on their babies’ behaviour.

Medication
Medical diagnoses are usually accompanied by medications. It’s tempting
for both parent and health professional to believe relief will come from
medication, but there are problems when we medicate babies for crying
even when we call it ‘colic’, ‘reflux’ or ‘wind’.

Most of the time the diagnosis and reason for medicating is guesswork
because signs and symptoms are not clear and we can’t ask the baby
what’s happening.

There is a consistent high failure rate—that is, the baby’s behaviour


doesn’t change for any length of time. Parents find every time they try
something new (change the formula, start medication, stop medication
and so on) the baby settles for a day or two then goes back to crying a
lot again.

One difficulty in assessing whether medication works is that research


shows a placebo effect of between 20 and 30 per cent (see above).

Medications can cause other problems such as heartburn, allergic


reactions, vomiting, constipation, rashes and even increased irritability,
which makes it more difficult to help the baby. And, over the years,
most of the popular wind, colic and reflux medications have been
discovered to carry risks far outweighing any possible benefits for the
babies. For example, atropine, alcohol, dicyclomine and cisapride (see
below).

Drugs that consistently stop the baby crying usually have a sedative
effect rather than doing something that eases the baby’s gut. They work
on the baby’s central nervous system, not on the digestive system, and
parents are often unaware of this. Sedating healthy babies who cry a lot
seems a risky business and not in the baby’s best interest.

Unfortunately situations happen where daily living becomes intolerable


because of a continually distressed, crying baby. Life with a crying
baby usually becomes intolerable because the mother is not getting any
practical help and support and is left alone day after day with her crying
baby. Sedatives may be resorted to as a way of easing an intensely
stressful time, not because the baby needs them. It is safer for a healthy
baby to cry than be sedated.

Here are the main drugs used for babies who cry a lot.

Colic/wind
Colic and wind medications for babies create a profitable market. New
ones appear all the time, making extravagant claims about curing babies’
gut problems. History reveals that this is not a new practice. Various
miraculous potions have been concocted and sold to parents for at least
two hundred years, often with the blessing of the medical and
pharmaceutical professions. Think things through before you waste your
money or buy something potentially harmful to your baby. Potions
marketed as ‘herbal’ or ‘natural’ need just as much scrutiny as any others.

Non-sedative
Infacol wind drops: Wholly made up of simethicone in a sugar-free
base. Simethicone is an anti-flatulent which supposedly works by
joining all the small bubbles together in the intestine so the large bubble
will be passed! A dose is given before each feed. Safe to use.

Gripe water: Gripe water has been around for a long time. It consists
of dill oil, sodium bicarbonate, water, sugar and alcohol. The alcohol
mildly sedates some babies the first few times it’s used and babies like
the sweet taste. Alcohol-free gripe water is available. If you use gripe
water, don’t overdo it. Too much sodium bicarbonate (a salt) is not
good for your baby’s kidneys.

Herbal teas: The use of herbal teas for babies is no longer


recommended because a lack of quality control in the manufacture of
herbal teas makes them unsafe because other herbs, weeds or seeds may
be present.

Herbal ‘wind’ preparations (often also called ‘natural’): These are


found in lots of health food shops and pharmacies and contain a variety
of different herbs. Parents often report a miracle change in their baby’s
crying after using one of these preparations; unfortunately the change is
usually only temporary. Always find out what is in the mixture—
occasionally quite dangerous sedatives are used in ‘natural herbal
mixtures’.

Sedative effect
Some wind and colic medications contain drugs which work on the baby’s
central nervous system, thus calming the baby. Although they are
promoted as reducing colicky behaviour by easing spasms in the muscles
lining the intestines, it is probably the effect on the central nervous system
which calms the baby, not the anti-spasmodic effect.

Dicyclomine: The most widely known of these is Merbentyl.


Merbentyl is based on dicyclomine, an anti-spasmodic drug.

Preparations containing dicyclomine have warnings on the labels not to


administer them to babies under six months—yet it’s the first three to
four months when babies are commonly diagnosed as having ‘wind’
and ‘colic’.

Until 1986 preparations containing dicyclomine were used freely for


crying babies. Preparations containing dicyclomine were at times quite
successful in stopping babies from crying so much, but mostly there
was an improvement for a few days then a return to the pre-dicyclomine
crying.

As these preparations were freely available, and as parents were hardly


ever fully informed about all aspects of ‘colic’, it meant mixtures
containing dicyclomine were frequently over-used and abused.
Excessive use can cause drowsiness, a decrease in urine output,
constipation and heartburn. Preparations containing the drug were
declared unsafe for babies under six months. Looking objectively at all
the medications given to healthy, crying babies, dicyclomine is not as
potentially dangerous as some others which have no warning.

The problems associated with the use of dicyclomine are similar to


those of any medication given to healthy crying babies. Much
guesswork is involved, so it’s risky to use any medication unreservedly,
hoping for something positive to happen. The risks are increased when
the drug being used depresses the baby’s central nervous system.

If you do use a colic preparation containing dicyclomine:

Be aware of its limitations. It is not a miracle cure for crying.

Use strictly as directed. When you reach the maximum dose, stop using
it and dispose of it down the sink or the toilet.

Donnalix Infant Drops: Donnalix Infant Drops are sold over the
counter and contain hyscyamine sulphate, atropine sulphate, hyoscine
hydrobromide and alcohol in a flavoured syrup. Use of this drug
contributes to reflux heartburn. Atropine can cause dilated pupils, a dry
mouth, rapid heartbeat and constipation. Research has consistently
shown atropine derivatives to be of no value for ‘colic’.

Sedatives
The following drugs are sedatives. They work by putting your baby to
sleep, not by treating a pain in the tummy.

Phenergan: Phenergan is an anti-histamine that has a tranquillising


effect. There are serious risks with using Phenergan, which include
extreme drowsiness and depressed breathing or, alternatively,
hyperstimulation and poor coordination. Phenergan is available only on
prescription. It is not advised for the under twos.

Phenobarbitone: It is unfortunate that preparations containing drugs


such as atropine and phenobarbitone are still being prescribed for
healthy, crying babies often without the parents being aware of what it
is they are giving their baby. Phenobarbitone is a barbiturate which
depresses the whole nervous system and causes abnormal deep sleep. It
is also dependency-producing, which means babies who are taken off it
suddenly may convulse.

Phenobarbitone has a place when used for babies suffering from drug
withdrawal (born to substance-addicted mothers although increasingly
other drugs are now used), babies born with severe birth trauma and
occasionally for other specific medical problems. It is inappropriate to use
it for healthy babies who cry a lot. Never use mixtures containing this
drug.

A WORD ABOUT PARACETAMOL AND IBUPROFEN: Tempra,


Panadol and Dymadon are examples of paracetamol. Nurofen Junior and
Brufen syrup are examples of ibuprofen.

Paracetamol is a medication for babies when they have a fever or are in


pain (following surgery). Paracetamol is not useful for crying babies when
the cause of the crying is unclear. Parents often resort to a dose of
paracetamol when they can’t think of anything else to do. Doing this
occasionally is okay, bearing in mind that paracetamol has a mild sedative
effect on some babies the first couple of times they have it.
Ibuprofen is an anti-inflammatory drug that is also used for symptoms of
fever and pain in babies, toddlers and children. Both paracetamol and
ibuprofen are equally efficient in reducing fever and pain. Like
paracetamol, ibuprofen is not appropriate for healthy, crying babies when
the cause of the crying is unclear.

Ibuprofen should not be used when there is a family history of asthma or


other allergies. If in doubt check with your family doctor.

The safety of both drugs depends on them being used correctly. There is
now a multitude of preparations available, all with their own individual
strength and dose. It is very important to calculate and measure the dose
correctly according to the manufacturer’s instructions. If in doubt, check
with a second person.

Paracetamol and asthma risk


A study published in 2008 suggested that giving paracetamol in the first
year of life significantly increased the risk of asthma in childhood,
however, allergy specialists say that while serious consideration should be
given to the study it does not provide clear-cut evidence that paracetamol
causes asthma. At the time of publishing (2009) it is still advised to use
paracetamol as it is viewed as the safest analgesic drug—ibuprofen, as
previously mentioned, can provoke asthma attacks in susceptible children
and aspirin can cause a serious life-threatening side-effect in babies,
toddlers and children, called Reye’s syndrome (children under the age of
twelve should never be given aspirin). Parents are, however, strongly
urged not to overuse paracetamol. Its main use is for serious fevers—
38.5°C or above or for post-operative pain. Neither paracetamol nor
ibuprofen should be given routinely prior to immunisation or repeatedly
dished out for vague ‘sleeping’, ‘teething’ or ‘colic’ symptoms/problems
in otherwise healthy babies.

Gastro-oesophageal Reflux Disease (GORD)


After twenty years of routinely medicating babies with a range of drugs for
‘reflux’ there is more and more evidence that unless a baby has a definitive
diagnosis of acid reflux (heartburn), the commonly used medications do
not do anything useful for vomiting/regurgitation, gagging, back arching
or excessive crying.

This includes Mylanta, Gaviscon, milk thickeners and ‘reflux’ formula—


see chapter 10 for a discussion on the use of thickened formula. One
commonly used drug, cisapride (dished out with gay abandon in the
1990s), has been shown to be not only ineffective but also unsafe.

Acid-reducers such as Zantac and Losic are still routinely used for many
crying babies, but as acid reflux is uncommon in the majority of babies
these medications should only be used when there is a definitive diagnosis.
Occasionally, when there is no doubt about the diagnosis, a tiny dose of an
antibiotic is used to hasten the passage of food through the gut to minimise
the regurgitation and heartburn.

Unfortunately because of the uncertainty surrounding GORD, it is possible


that occasionally a baby with the condition may miss out on medication
that would help. At the other end of the spectrum there’s no doubt a whole
host of babies are getting medication for a condition they don’t have.

Non-medical approach
The non-medical approach to excessive crying suggests that most of the
time when babies cry a lot it is not caused by an organically defined
condition; rather, it is the way the baby is responding to her new
environment.

Certainly non-medical reasons are only theories or someone’s point of


view, but so are most of the medical theories as to why some healthy
babies cry so much. Many parents find the non-medical approach helpful
as it avoids diagnostic tests, experimental medication and meddling with
feeds. This approach looks at ways to help parents adapt to the baby and
what she’s doing rather than trying to stop the crying or ‘cure’ the baby,
and involves looking at all the options parents may try and changing them
when they don’t suit. Like the medical approach the non-medical approach
may not stop the crying but it can help the mother feel better about herself
and her baby and give her confidence to carry on without feeling the need
to get on the medical roundabout.

Here are some non-medical reasons why some healthy babies cry a lot.
Sleep
I believe an inability to get to sleep and go back to sleep (unrelated to any
other factor) is the major cause of distress and crying in healthy babies.
Learning to sleep is one of the ‘tasks’ young babies need to undertake.
Learning to sleep involves:

Learning how to ‘hold themselves together’ to get to sleep. This is


difficult for some babies—not able to get to sleep, they are unable to
enjoy being awake. Their movements become jerky, they do not make
eye contact and as they become more and more agitated their crying
builds to a crescendo.

Learning how to go back to sleep when suddenly woken from light


sleep and dreaming sleep (REM). As mentioned previously, babies have
long periods of REM sleep from which they are easily woken. The
waking might be due to normal body functions (for example, a poo
behind the anus is a strange sensation to a baby, as is passing wind until
she gets used to how it feels) or things relating to baby behaviour such
as the startle reflex. Once awake, the baby cannot get back to sleep,
starts to cry and eventually ends up crying uncontrollably, becoming
more and more tense.

Learning how to go back to sleep following the normal, brief wakings


in between sleep stages instead of coming fully awake and crying.

Frustration from over-tiredness


Babies are only able to stay happy and awake for relatively short periods.
The less sleep they have, the more crying there is likely to be. For many
crying babies it is the lack of sleep causing the crying, not the crying
causing the lack of sleep; a situation that is difficult to change until the
baby is able to sleep more and longer.

On the subject of ‘boredom’


Boredom is often raised as a possibility when considering the reasons why
babies might be crying a lot. I have always been reluctant to go along with
this idea as I find it a little glib and ultimately not that helpful. Certainly
babies can be distracted momentarily from whatever their problem is by
showing them moving objects, talking to them, dancing around the room
with them, reading to them, showing them the waving leaves on a tree and
so on. But as over-tiredness is a prime cause of very unsettled babies I
think that pushing boredom as a reason for their behaviour brings the
strong possibility of an already exhausted baby being over-stimulated to a
degree that will make the problem worse. When babies sleep well, the
boredom issue, by and large, is not a consideration because babies who
sleep well are generally much happier when they are awake than those
who don’t. Before searching for endless anti-boredom activities, it’s
probably better to try to calm your baby and get her to sleep.

Low sensory threshold


A number of all healthy babies respond in an exaggerated way to light,
movement, noise and their own normal body functions (burping, startle
reflex, intestinal movements, passing urine or having a poo). Babies like
this eventually also have trouble sleeping until their systems get used to
the ‘overload’ of sensations and movements. It is thought that babies who
have difficult births or sick premature babies are more inclined to have low
sensory thresholds, but this is not always the case.

The temperament of the baby


The role of the temperament of the baby comes up time and time again. A
small amount of evidence exists that excessive crying may relate to a
‘difficult’ temperament, but I have a problem with this approach.

Apart from the fact that seeing the baby as ‘difficult’ might mean a
medical problem is overlooked, suggesting that a baby who has only been
on the planet several weeks is ‘difficult’ when we don’t know the reason
for her distress is somewhat of an insult to a small person at this stage of
her life when we have no idea what sort of a person she will be. One of the
things I have learnt about being a parent is to be patient and wait for the
end of the story.

Other contributing factors


When a baby is very unsettled and crying all the time, everyone
unfortunately starts to look for someone or something to blame. Blaming is
destructive, not constructive, and great care has to be taken when assessing
the possible role the following factors play so that they are not used to
make mothers and fathers feel guilty and to blame for the predicament the
family is in. I am mentioning them because I do think in some crying baby
situations they play a part, and acknowledging them sometimes means
they can be changed or help can be obtained from other members of the
immediate or extended family. Here they are:

Building extensions to the house;

Moving house;

Money worries;

A major career change by the parent in paid work;

Overseas visitors who stay a long time;

Relationship problems;

An unsympathetic partner;

Isolation and loneliness suffered by the parent at home with the baby
(usually the mother);

Great emotional stress suffered by one or both parents;

Ill health of one or both parents;

Unrealistic expectations of life with a baby.

Non-medical options for babies who cry a lot centre around helping the
baby not cry so much and helping the parents live with the crying. All of
these things below help some of the time but there is no single option that
consistently works all the time for every crying baby. Of course, any of the
following can be done as well as using medication if the baby has been
given a diagnosis and treatment.

Most of these options have already been described in chapter 14, so please
refer to that section if you want more detail.
A dummy: Distressed babies often need to suck a lot, not from hunger
but to relieve their distress. The breast can be used for comfort if the
mother is happy to do that.

Calm handling: Sharp, jerky movements signal distress which makes


the baby more alarmed; wrapping her firmly in a flexed position and
avoiding over-stimulation by lots of different people helps.

Carrying the baby in a sling or front-pack.

A deep, relaxation bath sometimes works wonders.

Letting the baby cry is quite all right when there is nothing else to do,
especially when the parents feel worn out and tense. Well-fed, tired
babies often sleep well after crying when left for a short time. I suggest
about twenty minutes. Parents shouldn’t hesitate to pick up their baby
any time they think they should, but there needs to be a balance
between constantly picking up and putting down and allowing the baby
a reasonable time to get to sleep.

Gentle rocking, patting, music or going for a walk are all soothing
techniques that have been used for thousands of years to calm babies.

Getting help
Health professionals
Unfortunately a lot of health professionals don’t get top marks when it
comes to helping and supporting families with crying babies. Apart from
the fact that there are always unhelpful people in any group of
professionals, there are other reasons why this appears to be so:

Parents caring for a crying baby often expect a miracle answer to safely
stop their baby crying. Such an answer doesn’t exist.

Health professionals who deal a lot with healthy, crying babies often
just get bogged down in the sheer numbers of difficulties with unsettled
babies and take the tack that in the long run the difficulties resolve
whether they spend a lot of time with the mother and baby or not. Some
health professionals lose interest and look for the quick answer or have
a stock answer or every crying baby situation.

Many parents never give the health professional feedback. They see a
health professional once, never think to tell him or her the advice and/or
treatment didn’t work and go on to the next health professional.
Consequently some health professionals just keep dishing out the same
old recipe not really knowing whether it makes any difference to
individual baby crying or not.

Health professionals who have large numbers of clients to see or whose


fee structure limits time per client may not be prepared to spend time
counselling and comforting a mother and her crying baby once they are
confident the baby is healthy, in a good home and getting the right
food.

When looking for professional help the challenge is to find someone you
trust to be the major adviser. It is quite reasonable to get a few different
opinions, but you need one person who is flexible; someone you like and
trust and feel confident with; knowledgeable enough to give you an
objective summary of what you are being told so you are fully informed;
supportive—this means he or she supports you in whatever action you take
even if he or she doesn’t agree with it (providing it doesn’t pose risks for
the baby).

The major health professional may be a child and family health nurse, a
family doctor, a paediatrician, a psychologist or a social worker.

Help from the family care centres


Family care centres are government-subsidised centres which offer help to
mothers and babies and frequently play an important role in helping with
crying babies. These centres usually give mothers an option of staying for
the day or staying overnight for up to a week. Family care centres are
found in every capital city and in regional rural centres.

If you go to one, go with a realistic idea about what can be achieved.


Chances are the staff will not discover exactly why your baby is crying so
much, but they can help you in these ways: You get some sleep; they can
reassure you that your baby is medically fit; you eat properly; you will
receive moral support; you will be assisted with basic baby-settling skills
and gain some ideas of what to do when the baby cries.

If you are isolated, a family care centre is a way of meeting other women
who are going through the same experience. If you are depressed and/or
angry, there are trained staff to help you with these feelings.

Family care centres do not suit everyone. Their approach to babycare is


fairly structured, some of them do encourage leaving the baby to cry for
short periods and they usually attempt to establish some sort of routine. If
you don’t believe it’s all right to let babies cry for short periods and
routine is not your style, a family care centre may not be for you.

The results achieved in family care centres with young babies are not
always permanent. Babies have a sneaky way of sleeping more and crying
less in these places only to revert to crying a lot and sleeping less when
they go home. This can have a devastating effect on a mother’s
confidence. Try not to be dismayed if this happens to you. Family care
centres have unlimited staff to do lots of rocking and patting on rotating
shifts. They are also not trying to run a house and care for a baby twenty-
four hours a day, seven days a week.

Other help
Unless you have a miraculous response from seeing a health professional,
visiting a family care centre, changing your diet or your baby’s formula or
by giving medication, you will have to live with the crying.

I have used the word ‘parents’ a lot in this chapter rather than ‘mother’ to
recognise that fathers as well as mothers have crying babies. I also
recognise that men are sharing the ups and downs of parenthood more
evenly than was the case in the past, but it still must be acknowledged that
it is often the mothers who are caring for and spending the long, often
lonely hours with the baby. Fathers have avenues of escape not available
to the mother, and the crying baby remains primarily a woman’s problem.

Practical help is vital and it is sad to see how few women in our society
looking after a crying baby receive any. I am sure there would be far less
diagnosing and medicating of healthy babies if more consistent, easily
available help and company was available for women who need it during
the first three to six months after birth. It’s amazing what a difference it
makes just having someone else in the house who’s just there even if they
are not directly helping with the baby.

When practical help and company is not available, the following ideas
provide limited help if you can arrange it.

Have you got a trusted friend or family member who doesn’t bog you
down with endless advice and who doesn’t see anything odd about a
baby who cries a lot who will mind your baby and give you a break on
a regular basis?

Can you arrange help with the housework? Can you pay someone for a
while? What about asking one of your relatives who keeps burbling on
about ‘wind’ to do the shopping or the dishes or something practical
instead? Can you put in some earphones and let your baby cry while
you clean up? You will feel much better, and chances are your baby is
going to cry anyway whether you walk the floor with her or clean the
house. If you can restore order you will feel better, more in control and
she may go to sleep.

Send for your mother if this is appropriate. Go to your mother if she is a


tower of strength who doesn’t mind a crying baby around the house.

Try to work out what makes you feel better, then do whatever you feel
the need to do until your baby is calmer. For example, frequent trips to
see your major health professional (the right one won’t mind) or
frequent day visits to a family and baby centre. Mother and baby groups
can help if there are any in your area. Don’t forget that the Australian
Breastfeeding Association (ABA) runs groups. Talking to sympathetic
friends on the phone also helps.

Managing angry feelings


At some time or another every parent feels angry or irritated with their
baby or with the situation they are in, which directly relates to the fact that
they have a baby. Babies bring a lot of pleasure, but they also bring
frustrations. A baby disrupts adult lifestyles and limits the mother’s
independence. She may also throw up, cry a lot and not sleep at the most
inconvenient and unpredictable moments. Angry or irritated feelings may
range from a fleeting sensation to feelings so intense the parent feels he or
she could easily do something they might regret. As the mother is the one
with the baby most of the time she is likely to experience this feeling more
intensely and more often than the father.

When the baby is crying for a large part of every twenty-four-hour period,
angry feelings are normal. So are negative feelings about the baby from
time to time. It’s important to blow off steam to someone and men should
allow their partners to express feelings of anger and to say rude things
about the baby without showing shock and horror. Lots of the women I see
say all sorts of nasty things from time to time then feel much better
because they have been allowed to say them. Nearly all the time these
feelings are transient and the parent has no intention of acting upon them.
The feelings go away when things improve.

Nevertheless, there may be times when you feel out of control and that
there is a chance you might hurt your baby. Put the baby in her bassinet in
her room and go as far away as you can. Call someone immediately: your
mother; your partner; your child and family health nurse; a twenty-four-
hour family and baby centre; Casualty at your nearest children’s hospital
or local hospital; the nearest child abuse prevention service. And don’t feel
embarrassed to get help (see the Resources section).

Can having a baby who cries be


prevented?
Probably not. Until we know more about the precise reason why some
babies are so unhappy during the first six months of life it is difficult to
predict exactly what may or may not contribute.

Care during pregnancy and changing some negative lifestyle habits might
help, but there will always be a considerable number of crying babies born
to parents who take every care and a number of placid babies born to
parents who are very careless about their personal habits. It sometimes
seems very unfair but remember, by taking care and providing the right
environment you are giving your baby a wonderful life and future which
extends way beyond crying difficulties in the first six months.

Care during pregnancy


Eat plenty of fresh food, cut down on takeaways and refined food. Take
steps to avoid food you have problems with. Stop smoking—research does
show a higher incidence of babies who cry excessively in homes where
one or both partners smoke. Avoid alcohol and drugs. Try learning
relaxation techniques. Even if these things don’t make a difference to how
much your baby cries you will manage better. Looking after yourself and
your body also removes an element of guilt which makes you less stressed.

The non-crying baby of other cultures


By other cultures I am referring to indigenous or traditional cultures as
opposed to western or industrial cultures such as ours. Observations and
anecdotal stories from other cultures suggest babies don’t cry there the
way they do in our culture (perhaps none of them have reflux?). I’m never
too sure how useful this information is to a woman gallantly doing her best
for her crying baby. Suggestions to care for babies here the way they are
cared for in traditional communities are for most women in our community
unworkable.

Constant references to the ‘non-crying baby of other cultures’ suggests a


superior style of mothering which western women can’t quite achieve—so
no wonder their babies cry a lot! I find this approach not particularly
helpful and potentially damaging to our women’s self-esteems.

It does appear that in some other cultures the work of motherhood is not
left entirely up to one person the way it is here, so a baby can be handed
around to many relatives, which gives the mother some blessed relief. Our
society tends to elevate pregnancy and childbirth to unrealistic romantic
heights then leave women on their own to struggle with the task, making
them wonder what they are doing wrong when at times it all seems too
much.

However, many things about being women and mothers in our society are
wonderful. Few of us would care to live the way the majority of women
have to in other communities. Rather than making mothers here feel guilty
about their inability to live and care for their babies the way it might be
have been done in other communities or in other eras, I would like to see
more attention paid to helping mothers in the context of their lives right
here, right now.

Last hints to help you through


Try not to blame your baby, try not to blame yourself. This time is part
of your life story together. Think how you will laugh about it when she
is twenty-one.

When you can, try to look ahead and make some plans for an optimistic
future so you don’t feel completely bogged down in the present. Talk
about holidays, perhaps schooling and some nights out when the baby is
calmer.

Partners, work together! It is vital. The mother shoulders most of the


burden so, father, please support her approach. Organise shift work at
the weekends. Don’t blame each other.

Try whatever you think is reasonable. You will not ‘spoil’ your baby by
picking her up all the time, nor will you damage her by sometimes
letting her cry.

Never do anything that is suggested that causes you added stress, major
inconvenience or goes against what you feel is right. Remember you are
in charge, not the health professionals or anyone else who feels inclined
to tell you what to do.

Some crying baby stories


My baby was terrible. He screamed all the time and was never happy when
he was awake. It started out as wind and I tried all the wind things, none
of which helped. Gripe water was the only one that helped a little bit. He
kept getting worse, especially after feeding. I only breastfed for a few days.

I went to a family and baby centre where they diagnosed reflux. After that
we started Mylanta and thickening the milk and started early solids. This
made a slight difference but he was still very difficult and it went on until
he was six months old at which time he ate more than he drank and
seemed to improve.

I was very tired and depressed and got very run down and sick. I couldn’t
enjoy him because he was so unhappy. I didn’t realise babies could be so
unhappy! I hadn’t had much experience with babies and other babies I had
known before I had my own always seemed happy.

It put a strain on my relationship with my husband because I was always


so tired, the baby took up so much time. I felt my husband wasn’t
understanding enough. Getting practical help with my baby was difficult
because he was so hard to look after—no one wanted to mind him or help
me.

SUGGESTIONS: Accept all help; prepare for the possibility of a crying


baby during pregnancy; the family and baby centre was a great help; try
not to take too much advice from friends and never compare babies.

My baby cried constantly. I tried to do everything I could to pacify him but


I couldn’t. I was reassured by health professionals he was normal and I
accepted that. As long as you get confidence from somebody that you’re
doing the right thing and not hurting the baby you’re okay—I managed.

I let him cry, shut the door and put the radio on. As long as they’re crying
they’re fine—it’s when they stop you worry.

My husband was very supportive and took him for lots of long walks. He
was a baby who constantly wanted to be on the move.

I did not medicate. I tried to stay calm and not get her up. I did not get
depressed.

It stopped at four months and it was a great relief when it did—heavenly in


fact. He’s been wonderful ever since. I felt like weaning because I felt it
might help but he thrived on my milk so I didn’t and I’m pleased I didn’t
wean.

SUGGESTIONS: Go for lots of walks; talk about it to the child and


family health nurse; make sure you’ve done everything then leave the baby
to cry or go for a walk.

From about six to seven days he started to scream from early morning to
5 pm and often at night as well. He didn’t just cry, he would scream; his
body was like a brick. He’d arch backwards. Occasionally I could rock
him to sleep then he would wake again.

I saw the child and family health nurse every week until he was eleven
weeks old. We tried gripe water, Infacol and Mylanta but nothing made
any difference, although everything worked for a little while.

I was breastfeeding and had sore nipples and one episode of mastitis,
however, despite everything, his weight gains were good.

At eleven weeks I went to a family and baby centre and consulted a


paediatrician. I continued to breastfeed but started to complement with a
soy formula on the advice of the staff and paediatrician. As well treatment
for reflux was started. I kept him upright as much as possible. This seemed
to help.

By sixteen weeks he was much better. He was fighting the breast so much I
weaned at this time but he fought the bottle as well.

I struggled on for another month, at which time he was on three meals a


day and whatever he would drink. By then, although he never slept in the
day, he did sleep at night.

By six months he had stopped screaming.

How did I feel? Mentally I felt inadequate and as if I was not doing a good
job. I felt that I should have been able to manage. I felt that people were
talking about me and that it was never going to end. I felt that having a
baby was the biggest mistake of my life. I got very depressed and put on a
lot of weight. My husband was available and supportive and never blamed
me but it definitely put a strain on the marriage. I kept wondering why all
my friends’ babies were happy and placid and mine wasn’t. Why me?

Through it all I did have a special feeling for him even though there were
times I thought I hated him. no one is ever prepared for how much a baby
can cry. Now I love him to bits. He turned into a fantastic toddler and
many of my friends’ placid babies have turned into holy terrors.
SUGGESTIONS: It’s vital to have your husband’s and friends’ uncritical
support. I found the child and family health nurse and the family and baby
centre helped. In the early weeks the lactation consultant helped with the
breastfeeding. Overall, none of the medication helped, however Mylanta
seemed to when he was four months old in conjunction with keeping him
upright. The worst advice for me was to leave him to cry.

The first week was okay, then at two and a half weeks she started to cry a
lot. The worst time was from 7 pm to midnight. We couldn’t settle her—we
tried everything. I tried gripe water, warm water, Infacol Wind Drops and
Mylanta. The medication made no difference. We tried baths, car rides and
long walks.

I became exhausted and tearful, but not really depressed. Not knowing
what to do, I blamed myself. My husband found it difficult because he had
to get up early for work but he didn’t blame me and our relationship didn’t
suffer as we worked together.

The child and family health nurse suggested going to a family and baby
centre. My husband wasn’t keen as he thought we could sort it out. When
she was in the family and baby centre she was wonderful. No crying. After
three days she was great, so I went home very much refreshed after lots of
sleep. At home she started crying again but the time at the family and baby
centre made me see things in perspective so I managed much better. I
endeavoured to get her to sleep in her cot rather than in my arms. The
family and baby centre scheduled her feeds strictly. I tried to do this but it
didn’t work for me. I then decided to breastfeed her whenever. And to keep
her in bed with us at night.

At three months she stopped crying.

IN HINDSIGHT: Medication didn’t help and was a waste of money.


Nobody told me to ‘follow’ the baby so I nearly went mad trying to follow
everyone’s advice, none of which seemed to suit me or my baby. The
family and baby centre let me catch up on some precious sleep and gave
me a different perspective on how things should be. Support for the mother
is vital—before you have a baby you have no idea how hard it can be.

FOR MORE INFORMATION


Chapter 5: Choosing Baby Products (dummies)

Chapter 6: Breastfeeding Your Baby For the First Two Weeks (weighing babies;
foremilk and hindmilk; burping)

Chapter 7: Bottle Feeding Your Baby For the First Two Weeks (what’s in formula?
making the milk)

Chapter 10: Early Worries and Queries (heat rash, hormone rash; medicating babies; growing
teeth)

Chapter 14: Sleeping and Waking in the First Six Months (unsettled period; settling techniques)
16

For Parents
Previous chapter | Contents | Part II
Taking care of yourself: the first week
after birth
During the first week you may have a few concerns and minor discomforts
so here is some useful information.

Vaginal blood loss: May be heavy for the first four days, becoming
thinner and lighter after this. The colour changes in the first ten days
from red to pink-brown and then becomes a creamy white. The creamy
white discharge may continue for up to six weeks. It is also normal to
have some light bleeding and spotting for up to six weeks. Because of
the risk of infection, tampons should not be used until after the first six
to eight weeks (a small number of women menstruate at this time).

Afterbirth pains: Are more commonly felt by women who have had
previous pregnancies. The pain is caused by a hormone called oxytocin,
which causes the uterus to contract and discomfort may be experienced
for three to four days. Use a hot water bottle for pain relief, taking care
not to burn yourself or your baby. For severe pain, paracetamol is safe
to take while breastfeeding.

Stitches: If you have stitches, a midwife will check them every day for
five to seven days to make sure they are healing well. Stitches often feel
very tender for the first week or so depending on the extent of the tear
or the episiotomy. Most heal quickly, the worst of the discomfort fading
in three or four days. The stitches usually dissolve in seven to twelve
days. If it is taking longer and you are feeling uncomfortable, it’s a
good idea to ask your midwife or family doctor to have a look and
remove the stitches. Avoid using talcum powder and creams until the
stitches have dissolved and the area is well healed. Any pain should
have disappeared after two weeks. If your stitches are still painful after
this time, see your family doctor.

Haemorrhoids: Haemorrhoids are swollen veins just inside the anus


and can be very painful and even bleed. They are usually temporary,
subsiding without any major treatment, but are troublesome for up to
three months for some women. In the first forty-eight hours, cold packs
give some relief. Haemorrhoidal ointment is available as well, but be
careful not to get the ointment on your stitches. It is important to avoid
constipation by drinking plenty of fluids and adding extra fibre to your
diet. Sometimes it is necessary to take a fibre supplement such as
Metamucil.

Contact your midwife, maternity hospital or family doctor immediately


for any of the following:

Increased bright red bleeding;

Fainting or dizziness;

A painful, hot, red area in the lower leg;

A temperature of 38°C or higher for more than two hours;

Burning or difficulty passing urine;

Painful breasts and a temperature above 37.5°C.

Postnatal check

See your midwife, family doctor or obstetrician for a general check of


your breasts, uterus and cervix at around six to eight weeks after the
bleeding has stopped—don’t worry about a small amount of spotting.

Those tired feelings


Mothers find they are often very tired during the first few months after
birth. Why? Your body worked hard to give birth and even though initially
you feel exhilarated and excited, it takes a while to recover physically,
especially while you adjust to night feeds and the normal anxious moments
that accompany looking after a new baby. If you had a caesarean section or
any birth complications the recovery takes longer. Doing unfamiliar tasks
and using muscles not usually used is tiring until your body adjusts.
Always putting your baby’s needs before your own and not being able to
get other things done because your baby interrupts you makes you tired
too. If on top of all this your baby is unsettled and cries a lot and is awake
a lot at night, the constant lack of sleep will leave you feeling very tired.
Breastfeeding difficulties may arise which also contribute to fatigue.

How to help yourself


Remind yourself that time spent with your baby is more important than
anything else. Allow yourself time to settle her. Try to lie down at least
once a day when she is asleep instead of finding another job to do.

In only a few short months she will be sleeping longer at night and having
fewer feeds during the day and all this will be behind you. A lot of
breastfeeding problems can be solved or overcome in the first four to six
weeks. When this happens you feel a lot less tired.

Remember, you and your baby come first. If you make it clear, others will
get the message. Rather than ask your visitors if they want tea or coffee,
suggest they wash up or nurse your baby while you have a shower.

Switch off all advice (unless it is really helpful, sometimes hard to work
out) from well-meaning friends and relatives. Practical help from those
who want to do something will do a lot more to relieve fatigue than
endless suggestions about ‘wind’ and ‘a little pain’.

Put your feet up when you nurse or feed your baby. Can you learn to
relax? If you can it is very helpful as a fatigue buster. Use one of the tapes
and the simple suggestions in chapter 1 or go back to the relaxation
techniques you learnt at your childbirth education classes.

Try to eat sensibly. It doesn’t have to be a formal meal three times a day.
Simple food such as fresh fruit and yoghurt, fresh wholemeal rolls and
salad, cold chicken, frozen meals or takeaway is fine. If your partner, lover
or friend prepares a meal when he comes home, that’s even better.

Your body
Accept how you look for the moment. Please don’t buy or read those
ridiculous magazines that go into every miniscule boring detail of the
cleverness of the celebrity mums who are back to skinny perfection a week
after they give birth (most unhealthy). Or even three months after birth
(it’s their underwear and the airbrushed photography). Be proud of the
body that has nurtured your baby (I can assure you your baby doesn’t want
a celebrity mum as her mother) and be patient about getting back to pre-
pregnancy dimensions. Work on about a year—a much more realistic time
—to get back to ‘normal’. In the meantime wear clothes that are
comfortable and bright and make you feel happy. Exercise lifts your mood
and makes you feel lighter all over. After the birth, hospital staff or your
midwife will show you how to do some recommended exercises without
hurting yourself. Ideally it’s great to do these exercises, but most of the
women I talk to find they are too overwhelmed or too tired to set aside
time each day, even if it is only ten minutes, so if you’re not doing your
postnatal exercises you’re not alone.

If you are conscientious about exercise, keep to gentle routines for the first
few months. Light yoga which concentrates on passive stretches is
excellent. Make sure you have a qualified instructor.

If you find it hard to fit exercises into your new life, just try walking and
pelvic floor exercises.

Walking and babies go together. Start slowly and gradually increase the
distance.

Pelvic floor muscles support the vagina, uterus, bladder and bowel.
Exercising pelvic floor muscles helps your body recover from the birth and
prevents stress incontinence. Stress incontinence means that when you
cough, sneeze or jump up and down a small amount of urine is passed.
You don’t have to set aside a special time for pelvic floor exercises. They
are easy to do when you are resting, feeding your baby or anytime. Here’s
what to do:

Squeeze and hold the muscles around the urethra (where the urine
comes out), your vagina and your anus as if you are trying to stop
yourself passing urine, hold for three seconds then relax. Do this three
times.

Don’t tense your thighs or tummy or hold your breath. Don’t overdo it.
Start a day or two after birth and build up to fifteen to twenty-five a day
doing about five at a time.
Pelvic floor exercises are something recommended for all women
throughout life, so after the first three months start increasing the number
you do. Do as many as you are able to before the muscle tires. The
minimum aim is for 150 pelvic floor exercises a day!

Look after your back. Changes which happen to your body during
pregnancy and extra strain on your abdominal muscles mean back
problems are common after birth. The extra physical work also makes
backache more likely. You are most vulnerable in the first six weeks so
avoid lifting laundry baskets full of wet clothes or heavy nappy buckets.

Make sure change tables and bassinets are the right height so you can look
after your baby without bending over all the time. When you feed your
baby, get into a comfortable position with good support for your back. Ask
for help when you need it, especially to empty the baby bath or carry
shopping.

If your back becomes painful, physiotherapists, chiropractors and


osteopaths offer treatment and exercise, but look for someone familiar
with childbirth and postnatal care.

Your head
Expect postnatal drift—not being able to concentrate or remember things
is quite normal. Let yourself drift for a while. Take one day at a time; just
attend to your immediate needs.

As well as postnatal drift it’s common to have a wider range of emotions


than you normally do. Many women find they burst into tears easily, feel
elated one minute and depressed the next. Sometimes you might feel cross
and irritated over things others see as unimportant. Feelings like this are a
normal response to being tired and the stress and excitement which follow
any major change in life. Here are a few suggestions to help you if you are
feeling a bit strange:

Admit it’s rotten sometimes. Have a good cry when you need to. You
are under no obligation to float in a constant rosy glow.

A partner who shares the work as well as the joys makes an enormous
difference to handling topsy-turvy feelings.

Think about making contact. The first step might be talking to other
mothers at your child and family health centre. Get in touch with
members of your childbirth education class. Perhaps you made a friend
while you were in hospital—ring her up! Join the Australian
Breastfeeding Association.

If you feel your emotions are out of control it’s important to talk to
someone like your doctor, your child and family health nurse or staff at
a family and baby centre. Constant anxiety and depression can be
helped.

Take time for yourself whenever you can. Having someone mind your
baby while you get your hair cut, take a bath or simply stare into space
makes a lot of difference to how you feel.

Mothers’ groups
Mothers’ groups are usually organised by the nurse at the child and family
health centre (maternal and child health centre). Other mothers’ groups are
run by maternity hospitals, the Australian Breastfeeding Association,
churches and various private organisations, some of whom may espouse a
particular baby-raising philosophy, for example ‘attachment parenting’,
‘nappy-free’ or be tied in to a particular religion.

Mothers’ groups provide opportunities to meet other women experiencing


the similar joys and dilemmas that you are. You will find that while you
maintain contact with your work colleagues and friends who don’t have
babies you will make a new circle of friends who are parents. Many
women initially view mothers’ groups with suspicion but when they take
the leap discover that the understanding and support that they get from a
mother’s group helps immeasurably in adjusting to their new roles. Many
people make lifelong friends from their mother’s group. Having said that I
am aware that some women aren’t keen on group activities, some women
have unfortunate experiences in mothers’ groups and some women have
their own circle of support and friends without the need of seeking more. If
you feel you’d like to give it a go and don’t like the particular group
you’ve fallen in with try another one.
Other odd occurrences
Hair loss
Sudden hair loss is a distressing experience for a number of women. It’s
upsetting because it comes out in handfuls and seems like baldness is
inevitable. The mother feels as if it’s excessive, but it is usually not
noticeable to others. It happens from two to three months after birth and is
not related to breastfeeding, so don’t wean! The exact mechanism is
unknown, but thought to be related to the major upheaval the body goes
through at this time.

Some time after eight months the hair loss stops and twelve months after
the birth new, thick hair starts to grow. Beware of myths and wrong
diagnoses. It is not happening because of stress, nor do you need hundreds
of dollars’ worth of naturopathic dietary supplements or an expensive
course of hair loss treatment. It bothers me when mothers are talked into
expensive, unnecessary remedies which make no difference.

Wrist and arm problems


Wrist and arm problems during pregnancy and the first year after birth
happen to an appreciable number of women and to a large extent are
unrelated to their previous occupations. Some women find painful wrists
and arms most distressing and debilitating. The discomfort experienced
may mean they are unable to pick up their babies and have difficulty
sleeping.

Problems with wrists and arms can start at the end of pregnancy or appear
for the first time six to twelve weeks after the birth and continue for up to a
year when it nearly always resolves spontaneously. Many women suffer
mild forms of wrist and arm problems and never mention it.

It is usually diagnosed as Carpal Tunnel Syndrome and/or Tenosynovitis


according to precise symptoms. Carpal Tunnel Syndrome occurs when a
major nerve in the wrist is compressed, in this case thought to be due to
excessive fluid. Tenosynovitis is inflammation of a tendon in the arm.

The underlying cause in pregnancy and the first year after birth is
unknown, but the old scapegoat hormones may play a part, and the
condition is aggravated (not caused) by the physical work involved in
caring for a baby. Treatment should be conservative as, unlike Carpal
Tunnel Syndrome and Tenosynovitis in the rest of the population, it
resolves itself when it happens as a result of pregnancy and birth.

When looking for help, it’s important to find a family doctor or hand
specialist who is familiar with this phenomenon. This can be difficult;
despite the fact that it is not uncommon, very little is known about wrist
and hand problems relating to pregnancy. Splinting of the wrists in neutral
or slight extension day and night, diuretics, anti-inflammatory drugs or
cortisone injections are the usual medical offerings. Most of the women I
talk to manage with splints and massage once they know it will go, but it
does take some endurance; if you are finding life unbearable, cortisone
injections do relieve the symptoms quite dramatically and are safe to have
if you are breastfeeding. Needless to say, help with physical chores makes
a lot of difference. Surgery is rarely required so seek a second opinion if
surgery is suggested.

Night sweats and hot flushes


Symptoms like this are related to breastfeeding and are experienced to
some degree by a number of women. The symptoms are quite separate to
fevers and chills caused by mastitis, which is sometimes a bit confusing.
Mastitis symptoms are similar to the flu, whereas night sweats and hot
flushes happen to women who are otherwise well.

The uncomfortable feelings are due to low oestrogen levels. Low


oestrogen levels during breastfeeding are normal and essential for efficient
lactation. It is thought that the low levels of oestrogen can cause blood
vessels to become unstable (sometimes narrow, sometimes wide) which
causes the sweating, the hot flushes and sometimes palpitations.

Not much can be done. The symptoms are aggravated by heat, alcohol,
obesity, caffeine and hot food. They do not last for the entire time you
breastfeed. A dramatic improvement usually happens by twelve weeks, if
not before.

Acne
Facial pimples, lumps and bumps can occur in the first six to eight weeks
after giving birth. This generally settles with time. Don’t squeeze! There
has been no correlation found with breastfeeding. The eruptions are most
likely due to the hormonal changes that follow the birth.

Headaches
A small number of women get headaches when they are breastfeeding. If
they are troublesome it is always important to rule out any underlying
causes including dental or ophthalmic problems. Headaches can also
indicate impending mastitis. When there are no other causes, headaches
due to lactation could be caused by the release of oxytocin when the milk
lets down, or very full breasts. Most ‘breastfeeding’ headaches peak
around three to seven days after birth and resolve after a short period of
time. Make sure you keep well hydrated by drinking plenty of fluids
(water is good).

Anti-inflammatory or paracetamol medications are safe to take if


necessary.

Nausea
Nausea related to breastfeeding is reported by some women, usually in
conjunction with the let-down. This eases over time and can occur for a
few weeks to a few months.

Nausea is often also related to fluid intake (too much/not enough), low
blood pressure, fatigue, other illnesses, for example a urinary tract
infection, influenza or gastroenteritis, medication (particularly anti-
depressant medication) and, as is often common with mothers of new
babies, hunger because they forget or are too tired to eat properly.

Relationships
Think about your relationship with your partner. You and your partner
have to get to know each other all over again as parents, which takes some
thought and effort from both of you. It’s very easy to disappear into the
mother-and-baby world and lose touch. Your baby is important, but so is
your partner. Your partner needs to have access to you and the baby and
needs to talk to you about how he feels. Keep in contact with friends and
relatives. Your range of friends will change as you start to have more time
with people with babies and less with those without. Speaking with other
people who have babies is important for moral support and reassurance.

Arrange to go out without the baby when you can—even if it’s only for an
hour or two, it gives your relationship a great boost.

Bonding
The popularisation of the ‘bonding’ theory in the seventies and eighties
makes bonding seem like the super glue that holds mother and baby
together without which irredeemable damage is predicted for the baby.

Advantages have emerged as a result of the emphasis on bonding; it has


helped make it possible for women to have as natural a birth as possible; it
has changed inhuman, illogical practices in maternity hospitals and helped
more women establish breastfeeding successfully, but it gives many
women the feeling that there is a critical period where she and her baby
must bond otherwise all is lost. As well, there is no mention of a father in
all this so the onus is completely on the mother to get it right or else . . .

‘Bonding’ is falling in love with the baby during pregnancy or at birth, but
the normal range of feelings covers strong feelings of instant rapport to
numb indifference. When you’re in the latter group it does not mean you
are abnormal or that your baby will be deprived in some way if it takes
time for your relationship to grow. I talk to a number of women who are
never really comfortable with babies, but who find that as their babies
grow and become ‘people’ their relationship blossoms.

No evidence exists that premature or sick babies or babies born by


caesarean section suffer emotional deprivation because their mother didn’t
bond or bonded late. When things are difficult in the beginning, worry and
distress might overshadow your feelings of love for a while, especially if
your baby cries a lot during the first six months, but you will find the
mysterious bonding will gently arrive as the weeks slip by.

However, if you are ever seriously worried about your feelings for your
baby, talk to your child and family health nurse or your family doctor so
you can identify what the problem is and find out where to get help.

Conflicting advice
When you’re a new or not-so-new mother, one of the hardest things you
invariably find you have to deal with is the constant conflicting advice you
get from everyone you come in contact with, whether it’s a health
professional or someone in the supermarket.

Conflicting advice is a blessing and a curse. It’s a blessing (believe it or


not) because it allows for the many variations in human nature and
experience and provides for flexibility; it’s a curse because it raises doubts
at a time in your life when you are likely to be very vulnerable,
unassertive, sleep-deprived and unable to count to ten let alone work out
whose advice you’re going to take.

Advice comes from two sources—non-professional experts and


professional experts. The mother who is doing all the work is rarely
viewed as an expert and usually the assumption is made that she knows
very little and everyone else knows lots.

Non-professional experts are friends, family, neighbours and a whole


range of people you hardly know like the man on the bus and the woman
in the bank. Their advice is usually unsolicited and based on what they did
with their own babies.

Professional experts are people such as child and family health nurses,
general practitioners, paediatricians, a range of specialist doctors, social
workers, psychologists, physiotherapists, dietitians, occupational
therapists, lactation consultants, parentcraft nurses, midwives,
obstetricians, counsellors who belong to voluntary groups such as the
Australian Breastfeeding Association (ABA), staff who work in childcare
centres, pre-school teachers and pharmacists, to name a few. Their advice
is based on their academic qualifications, their professional experience
which varies according to what training they have undertaken, their hands-
on work and scientific research.

Having this extraordinary range of people around is the main reason there
is so much conflicting advice. Modern-day care of mothers and babies is
very fragmented, increasingly polarised and you are likely to be in the
hands of a different expert every step of the way as well as for every
different problem that might arise. Other reasons for conflicting advice
include tradition, fashion, scientific research and the fact that babies are a
mystery and can’t tell us what is wrong or how they feel.

Conflicting advice is here to stay—what can you do?


Understand that everyone is different and advice that suits one person may
not necessarily suit another.

Unsolicited advice from non-professionals is usually given with the best


intentions in the world. You’ll probably find yourself doing it once your
baby is older and you’re feeling experienced enough to offer a few tips to
friends about to have their first. Smile and say thanks and forget about it
unless it’s something you think is useful.

Conflicting advice from health professionals is harder to deal with,


especially in the early months. Try to avoid seeing a million different
people and find one person you trust.

Here are a few hints on dealing with advice from experts—remember if


you’re feeling confident and have no problems, you’re the expert. Don’t
worry about the health professionals. Consider these things with regard to
advice:

Is it practical and realistic in relation to your life? Have you been


offered some options?

Is it safe?

Does the person giving you the advice have any commercial interests
which may influence the advice?

Does the person have a lot of hands-on experience? Quite a lot of


written information is done by people who do not work in the field.

Does the health professional reject out of hand advice from other
‘experts’ or is he or she happy to help you work out what’s right for
you?
Is the advice conflicting or simply a variation on a theme and does your
health professional help you to see the difference? What most mothers
are looking for is guidance, not instructions.

Does your health professional make you feel confident and good about
yourself and your baby? If not, find someone else.

Don’t assume health professionals know everything—they don’t. You


are in charge and as the weeks go by you will regain your assertiveness
and confidence and learn to trust your own judgement.

For grandparents
Becoming a grandparent is a big emotional experience that brings heart-
thumping excitement and a fresh lease of life. Many grandparents
rediscover the intense feelings that they had with their own babies—the
unremitting watchfulness, the anxieties, the exquisite pleasure of each
small accomplishment. They worry and wonder, bore their friends witless
and secretly hope their children know what they are doing. Ideally,
grandparents shouldn’t have to face the staggering amount of work child-
raising demands, nevertheless, their role potentially involves much more
than that of interested spectators beaming on the sidelines.

What is the grandparent role?


Broadly, grandparents are a vital link to the past. They continue to be a
role model to their children and grandchildren. In the ideal world
grandparents provide mentorship, emotional support and reassurance,
humour and wisdom. Grandparents can provide a counter to the perceived
negatives of raising children and bring optimism, enthusiasm and positive
support to their children’s decisions to create families of their own.

Specifically, the grandparent role is not at all straightforward and varies


tremendously from family to family, culture to culture.

While distance, age and health impacts on the extent of their involvement,
grandparents can choose how much they are going to be involved with
their grandchildren practically, emotionally and socially. Some
grandparents are very ‘hands-on’ which may include regular childcare for
parents in paid work and/or taking children during the school holidays. A
small but increasing number of grandparents are raising their
grandchildren.

Other grandparents are not prepared to take a hands-on role. They may be
still in the paid-work force; they may want to use this time of their lives to
pursue an interest family life prevented; they may still be raising children;
they may be caring for their parents; they may have had so many
grandchildren they’ve run out of puff. Or, they (grandmothers in
particular) may feel they simply do not want to face the unrelenting rounds
of nappies, sleepless nights and early mornings, temper-tantrums and
potty-training all over again in their latter years.

Modern grandparenting—the realities


Becoming a grandparent is a wonderful gift flowing from the years of
investment and love that went into raising one of the baby’s parents.
Reams are written on the joys of being a grandparent but there can be a
side hidden beneath the layers of flowery sentiment that is not often
discussed.

Grandparents of previous generations had important roles as mentors


offering emotional support but, by and large, were not called upon to
provide the level of childcare, financial and moral support that is expected
by many of today’s parents from their parents. For some grandparents,
caring for grandchildren is not a burden but a genuine pleasure that brings
meaning to their lives regardless of the amount of time and effort involved.
Others find providing the level of care their children expect to be a
physical and emotional burden. They often don’t know how to refuse or
how to set reasonable limits. Some—grandmothers in particular—feel
pressured by both family and society to present a smiling granny face and
constant availability no matter what.

It’s a good idea to think beyond the sentiment and take some steps to avoid
as many irritations as possible so parents and both sets of grandparents can
get the maximum amount of pleasure from their blossoming new
relationship—with each other and the little people in their lives.
Preparing for the realities
Most parents look forward to becoming grandparents but there are some
important issues to think about. To avoid misunderstandings it’s helpful to
bring them up before the birth rather than bumbling along, playing it by
ear and hoping things will ‘work out’.

The biggest misunderstanding is invariably the mismatch between the


children’s expectations of how much practical help will be forthcoming
from the grandparents versus how much help the grandparents are
prepared to provide.

For the grandparents who are reading this, here are a few
things to think about:
The amount of practical help grandparents are able to contribute varies
tremendously. It’s up to the children to accommodate their lives
accordingly, not the other way around.

Ideally, clear guides should be given to the parents right from the start
about what grandparents are prepared or not prepared to do. In the
heady rush of the arrival of the first grandchild, avoid over-
commitment. Step back a little while you reacclimatise to the time,
attention and physical demands babies and toddlers need.

As other grandchildren are likely to follow, bear in mind how disruptive


it is to family harmony if one grandchild is perceived to have had more
of your time and attention than another has. Likewise, if one adult child
has had more access to your services than his or her siblings have had.

General practicalities
The first essential in maintaining a harmonious relationship is to
only give advice when you are asked.

New mothers often drown in a sea of baby lore lovingly bestowed upon
them by anxious grandparents who are likely to have had no close
contact with a baby for thirty years. I think this is the single biggest
error doting grandparents make and you’d be surprised how much
tension it causes. You can trust new parents, mothers in particular, to
ask if they want your advice.

Don’t be offended if your daughter/daughter-in-law seems to be mainly


getting her knowledge from health professionals, online or books (or in
my case, books other than mine). If you feel you need to read the books
she’s reading and/or the websites she likes so you are up-to-date with
the latest recommendations.

Accept with a smile names, surnames, manner of birth, naming


ceremonies, dietary matters, domestic and childcare arrangements and
choice of school. Matters such as these are no longer your concern
unless they are illegal or dangerous.

Most extended families work better when there are structured


arrangements about visits. Sudden arrivals on either side—unless it’s
occasional—can be a source of irritation and inconvenience.

If you live at a distance, especially overseas, visits need to be carefully


planned so conflict doesn’t spoil the time together. Long stays can be
difficult to manage amicably in small houses. Thought needs to be
given about how everyone is going to deal with being in close
proximity for an extended time. Long visits need tolerance, goodwill
and organisation to make them positive for everyone.

Specific points in relation to babies


Here are the common things I hear about that cause stress between
generations when a new baby arrives:

Support and practical help are what’s needed. Constant suggestions as


to why baby is doing what she’s doing from grandparents undermine
the mother’s confidence—it’s better to accept the baby the way she is
and avoid labels like ‘good’, ‘spoilt’, ‘windy’, ‘naughty’ and so on.

There are many day-to-day options (and night-to-night) for looking


after babies and your child might choose different options from the ones
you chose. For example, she might breastfeed when you bottle fed, she
might carry baby all day while you were more into routines.
Alternatively she might be prepared to let her baby cry to sleep,
something you would never have done, and so on. Accepting and
supporting her choice without negative comments is important.

Many things change according to the latest research especially in regard


to baby safety, and especially in relation to where baby sleeps. If you
are in doubt about what the latest recommendations are go to
chapter 11.

Solids (that strange name we give to the mush babies first eat) are not
usually started until four to six months. Giving babies solids before then
has no advantages for most babies and doesn’t make them ‘sleep
through the night’.

Breastfed babies don’t need water in between feeds. Nor do formula fed
babies unless it’s very hot.

Breastfed babies (and quite a few formula fed babies) generally can’t be
fed every four hours. Flexible feeding times are needed, which means
there may be times when the baby is breastfeeding frequently. Let your
daughter do it in peace without constant reference to the number of
feeds the baby has had: ‘Oh, you’re not feeding her again are you?’

Babies don’t automatically start ‘sleeping through’ at eight weeks—or


necessarily at any age up to three. When young babies spontaneously
sleep longer at night it’s a bonus. There is no safe way you can make
young, healthy, thriving babies stop waking at night.

Regular weighing of healthy babies is not necessary unless the mother


wants to do it.

Older babies often suddenly start to perform when one of the


grandparents comes near them. It is normal for babies between nine and
twelve months to become very wary of strange faces and places but
why it’s so often a grandparent is hard to say. It’s not permanent, nor is
it personal or caused by anything you are doing wrong. If it happens to
you, try to take it in your stride, stay calm and don’t overwhelm the
baby with too much attention. For more information refer to stranger
awareness and separation anxiety in chapter 32.

Grandparents’ rights
The two main areas where legal issues arise are:

Grandparents being denied legal access to their grandchildren


following family breakdown
Grandparents do have rights. Grandparents are able to seek contact and
time with their grandchildren when they have played an active role in
their grandchildren’s lives.

Grandparents as carers
Grandparents may become sole carers following the death of a parent,
substance abuse, mental illness, family violence or child abuse. Raising
a grandchild is done out of love and concern and at great personal cost.
Grandparents in this situation face many difficulties with include
financial problems, exhaustion and strained family relationships with
their own children. Recent changes have recognised the help
grandparents need raising their grandchildren and a range of services—
financial, childcare, respite—care are available.

For more information—any of the following provide further contacts for


legal, financial and other aid:

www.raisinggrandchildren.com.au—an excellent website donated by a


grandchild in memory of the grandparents who raised him. It is NSW-
based but is a good starting point for grandparents anywhere in
Australia.

Council on the Ageing (COTA)—(08) 8232 0422

Family Relationship Advice—1800 050 321

Health professionals you may come in


contact with
Child and family health nurse
The nurse at a child and family health centre has special training in all
aspects of early childhood. She or he (nearly always a she) is usually a
midwife as well and has expert breastfeeding knowledge. The service is
provided free. The nurse is there to help you with feeding and nutrition,
routine growth and development checks, counselling and specific baby and
child problems such as rashes, vomiting, crying, temper tantrums, toilet
training and sleep problems.

Owing to new government initiatives in Australia, eventually all mothers


will receive a home visit by a child and family health nurse or equivalent
(maternal and child health nurse and so on—each state has a different
name) after the births of their babies. You may find you will be asked what
can seem like daunting, even invasive questions. This is to help identify
women at risk of domestic violence and serious depression so they can be
helped as soon as possible—before there are serious consequences. If you
are concerned at any time by the questions, let your nurse know so it can
be discussed.

A child and family health centre is a great place to meet other mothers.
Most centres offer mothers’ groups, which women find an excellent
resource for company and the chance to make friends and compare notes.
You can also find out what is available in the community for families and
babies. The nurse there will tell you about immunisation and where it’s
available, the best books to read, discuss safety issues as your baby grows,
common medications and contraception.

Using the service


Maternity hospitals or midwives (if you have a homebirth) notify the
centre nearest your home or whichever one you designate shortly after the
birth of your baby. This is done with your permission. The decision to
attend a child and family health centre is up to you. Most women find it a
positive experience, especially with their first babies. If it is not, find
another centre, or if you feel confident and self-sufficient you may decide
not to go. You should always leave your centre feeling reassured and with
a positive plan of action if you have been having a few difficulties.

Telephone numbers and locations of child and family health centres are in
the phone book either under government services or in the main part under
child and family health centres. Each state has different names for their
centres and staff. Please refer to the Resources section for more
information.
Midwife
Midwives care for women during pregnancy, labour, birth and afterwards
for up to a month, sometimes longer. When employed by the government
their services are free. Some midwives work privately and charge a fee for
service. Fees are not refundable.

Mothercraft nurse
Mothercraft nurses are enrolled nurses with special training in early
childhood. They work in maternity hospitals, family and baby centres and
childcare centres. When employed by the government their services are
free. Some mothercraft nurses work privately for families for a fee. Fees
are not refundable.

Lactation consultant
A lactation consultant has an international qualification in human lactation.
Lactation consultants may be health professionals (midwives, child and
family health nurses or doctors) or people from any background with an
interest in breastfeeding who have the qualification. When employed by
the government their service is free. Most major maternity hospitals and
community services in Australia now have lactation consultants available
for help and advice. Some lactation consultants work privately and charge
a fee for service. Fees are not refundable.

An Australian Breastfeeding Association (ABA)


counsellor
ABA counsellors are mothers who have breastfed. They receive thorough
training over a minimum eighteen-month period. ABA has a strict code of
ethics which means all counselling is confidential and mothers or babies
with possible medical problems are advised to contact child and family
health nurses or doctors.

Confidential counselling and breastfeeding information is available from


ABA counsellors who work voluntarily on a twenty-four-hour roster. The
service is free.
General practitioner
The family doctor. Look for one with an interest in family medicine. Fee
for service is refundable.

Paediatrician
A doctor who specialises in the care of babies and children. Fee for service
is partly refundable.

Speciality paediatrician
Includes a range of doctors to cover every part of your baby’s body from
head to toe. Fee for service is partly refundable.

Psychologist
Psychologists help parents understand why babies do the things they do
and some parents find their approach useful for specific baby problems.
Psychologists are also available to help with personal or relationship
problems. A free service by psychologists is offered throughout the
government health system in community health centres and hospitals, for
which referral is needed and there may be a waiting time.

Alternatively, psychologists work in private practices and charge a fee for


service, a proportion of which is refundable from a private health fund.

Your other children


When it’s not your first baby, a lot of the things you agonised over the first
time around will pass you by. One of your main concerns this time will be
how your first baby adjusts to the newcomer. As well, parents often
wonder if they can possibly love another baby as much as the one they
already have; sometimes even feeling guilty that they are having another
baby, especially when the first child’s behaviour regresses, sometimes
alarmingly, in the first three to six months. If you get an attack of the
guilts, bear in mind that learning to live with others in a family is a vital,
even essential, part of human development. Most families have more than
one child and parents have no trouble spreading their love around many
children.

A great deal has been written on this topic and I find the parents I see are
very conscientious about preparing the first child but even with the best
will in the world things can still be a bit difficult for a while. Difficulties in
adjusting are temporary and it does take some children a little longer to
accept changes in the family than others. The age when it seems hardest
for children to adjust is from fifteen months to about three years. After the
age of three a child has more autonomy and is much more sure of her place
in the world and your affections. She is also able to look after herself to
some degree and has diversions such as friends and kindy. This doesn’t
mean it’s a mistake to have children close, but the closer they are the
higher your levels of energy and tolerance need to be to handle the hard
work when they are little.

Here are some suggestions for getting your first child ready for the big
event in her life:

Make any changes well before the baby arrives. It’s a good idea to sort
out sleep problems, bottles, dummies, potty training, bedrooms and
starting kindy before your baby is born, but do it well in advance. If you
don’t get around to it, it’s best left until at least six months after the
birth.

Talk about families and how they usually have more than one child.
Use your own or your partner’s as an example.

Wait until your pregnancy is obvious before telling her about the new
baby, but make sure you tell her before anyone else does. Let her feel
the baby and talk to her about babies and what they do as well as telling
her some funny, positive things she did when she was a baby. Help her
understand that the baby won’t be an instant playmate because babies
can’t walk, talk and so on.

Expand her life outside the home. Organising a social life for her means
she has other houses to visit and places to go. It’s also a way of
showing her she’s different from the baby.

Plan the arrangements for her care well in advance so she knows what’s
happening and ideally, knows and loves whoever is responsible for her
care.

Show her the hospital or the birth centre where you will have the baby
(unless you are having a homebirth). Tell her you will be only gone for
a short time and she will be able to visit. Let her help you pack your
bag. When she’s not looking, put in a couple of surprises for her to find
when she visits.

After the birth


Things often get off to a smooth start until the first child realises it’s a
permanent arrangement, at which time negative behaviour is likely to
surface. Most negative behaviour in children at this time is not directed
against the baby but against the huge adjustment that has to be made, so
your child might be very loving to the baby and pretty horrible to you.

Try to keep to your first child’s normal routine as much as possible and
any time you can spend with her without the baby helps enormously.
When you can’t do something she wants to do try not to make the baby the
excuse too often. Fathers can help a lot by minding the baby while you do
something with the older child or by doing something interesting with the
older child when you are busy with the baby.

Encourage friends to include your older child when they visit and bring
presents. If she is old enough to understand, prepare her for the fact that
babies attract a lot of attention—remind her that she did when she was a
baby. Let her know she can sit with you if she is feeling lonely or jealous.

Expect changes in your first child’s behaviour. Her concentration will be


affected by the change in her life. She may be more clumsy than usual so
make sure her environment is safe. Young children don’t understand
concepts of sharing and co-operation, so ignore as much negative
behaviour as is reasonable and give her lots of attention for positive
behaviour.

Help her not to feel guilty about jealous feelings by talking to her about
feelings, how strong they can be and the best ways of handling them.
Accept, even suggest that while the baby is a considerable nuisance at the
moment eventually she and the baby will be friends and will do lots of
things together.

Avoid situations where your older child may hurt the baby as it will make
her feel bad.

Try not to leave the baby’s belongings all over the house under the first
child’s nose. Don’t talk about the baby in ways that could hurt your child’s
feelings by saying things like ‘thank goodness we have a boy this time’ or
‘he’s a much easier baby’ and so on.

It’s unrealistic to expect your older child to automatically love the new
baby; this will happen in time. Encouraging the idea the baby likes her will
help her feel special to her new sister or brother.

Last but not least, remember you are only human and looking after babies
and young children is one of the hardest things anyone can do. Blowing
your stack sometimes or finding it difficult to manage more than one is
completely understandable. Don’t agonise over it or waste time feeling
guilty. As time goes by it all gets easier; some time between three and
seven months the first jealousy passes and your first child will forget what
life was like when she was the only one.

Postnatal depression
Many improvements have occurred in recent years in recognising and
helping women suffering from depression following the birth of a baby.

Thank goodness the views of fifty years ago have been challenged and
found wanting. The widely held belief then was that postnatal depression
was a sign of mental illness in women who rejected the role and normal
responsibilities of motherhood!

This change of ideas means that women who are depressed feel less
threatened and are more likely to seek help. Publicity about postnatal
depression, many excellent books, education of health workers and input
from feminists have all contributed to a larger number of women feeling
able to admit they need help and getting sensitive, effective treatment.
Unfortunately, despite these positive advances the reluctance of many
women to ask for help, as well as the lack of resources to provide help for
every woman who needs it for as long as she needs it, means we still have
not come far enough.

I have never been happy with the term ‘postnatal’ depression. Postnatal is
a misleading term in many ways because it implies a condition that occurs
directly after the birth of the baby. The term doesn’t encompass the
women who start to feel depressed further down the track when the
excitement and novelty of the baby wears off and when much of the
support they started out with is gradually withdrawn. In my work I find
most women have some degree of depression in the first two years after
birth which, for a few, continues on and off until their children are at
school or they are back in paid work. The label ‘postnatal’ depression also
has a tendency to make women feel abnormal when they are reacting in a
normal way to situations where they are under a great deal of physical and
emotional stress.

Like many mothers you may find that you feel tired and low for some time
after the birth because of the lack of unbroken sleep, the responsibilities of
being a mother twenty-four hours a day and the natural worry of your
baby’s wellbeing. Many women today are perfectionists in the workplace
and have learned not to make mistakes. The unpredictability of babies, the
trial and error that comes with caring for them and the slow realisation that
there are not always answers to every problem can be an enormous
adjustment that may take six to twelve months to come to terms with.
Distinguishing between baby blues, the normal mixed feelings that come
with adjusting to life with a baby, and what is known as postnatal
depression is an important part of getting the right help if it is needed.

The baby blues


As many as 70 per cent of women experience the baby blues to some
degree. They are likely to affect you within a week to ten days after the
birth and are strongly associated with hormone imbalance. It can be an
emotional and weepy time. The baby blues usually don’t last long, don’t
interfere with your sleep, your appetite or your ability to function and care
for your baby. Occasionally the baby blues can be prolonged and traumatic
and herald the onset of major depression, but some women find they are a
much-needed emotional release.
Postnatal psychosis
Postnatal psychosis can be a severe form of depression after childbirth but
is more commonly a different type of mental illness which occurs once or
twice every one thousand births. It is a disorder which requires prompt
intervention as left untreated there is a high risk of maternal suicide (and
less commonly infanticide). With prompt recognition and correct
treatment, postnatal psychosis has an excellent prognosis with full
recovery in a few months.

Mild depression (sometimes called postnatal


disillusion or postpartum adjustment)
I am using ‘mild’ here as a way of distinguishing one form of depression
from another, not to minimise the impact of the depressed feelings. It is
common for women at home with small children to suffer from mild
depression. The risk of this happening is higher if the woman has a history
of depression, but many women who do not have a history become
depressed during the early years of their children’s lives. If it happens to
be the father at home, then he is at just as much risk of becoming
depressed as the mother. Most depression suffered by people at home with
young children seems to be caused by the demanding nature of the job—
occupational depression.

Why does this happen? Looking after a baby can be lonely, constant and
unacknowledged work. It’s often stressful because of concerns about the
baby’s feeding, crying and sleeping patterns. A lack of personal spending
money, fatigue and a sense of being unappreciated and unrecognised for
the job all contribute. Coming to terms with the fact that the baby-care is
not going to be shared equally with their partners is also a significant
factor for many women who had expectations of this before the birth.

Mild depression like this tends to come and go at various times in the first
two or three years and is often exacerbated by things such as particular
developmental stages the baby is going through, sleep problems, baby
illnesses or financial or relationship problems. Mild depression is so
common that it is thought by many to be a normal part of adjusting to
parenthood and a natural consequence of being at home with babies and
toddlers when there is very little in the way of company and support.
This is not to suggest that this is how motherhood should be. The fact that
such feelings are viewed as normal is more an indictment on a society that
rationalises the miserable experiences of so many in such a way.

The perception that such feelings are the load we mothers have to bear
does not make them any less unpleasant or distressing. Nor should it deter
you from seeking help if you feel yourself sinking.

Mild depression usually responds to one-on-one counselling with the right


person, company (joining in groups), solving baby sleeping and feeding
problems, moving on past trying developmental stages and, for some
women, going back to paid work—even just half a day a week makes a
great difference.

Serious depression (usually called postnatal


depression and anxiety)
About 10 to 25 per cent of women—some studies suggest up to 40 per cent
in certain populations—suffer depression more severely during the first
months after birth, although it sometimes takes them a lot longer to
identify the problem. The causes for this are innumerable and as well as all
the occupational and adjustment reasons previously mentioned, other
causes may include:

A family history of depression or a previous history of mental health


problems and emotional difficulties.

Women who do not have a close relationship with the father of the baby
are more susceptible, as are women who do not have a circle of friends
or relatives they can confide in and express negative feelings to.

Women who live a highly organised lifestyle and who are used to being
in control may be more at risk.

Disappointment and feelings of failure following a forceps birth or a


caesarean section sometimes plays a part.

A constantly crying baby.

Life events such as moving house and relationship difficulties can also
be contributing factors.

The role hormone balance plays is unclear, but it seems unlikely it plays
a major role in postnatal depression. However, hormone imbalance does
not account for the number of women who become seriously depressed
months after the birth.

Women who have a biological vulnerability to feeling highly emotional


under stress.

The causes of depression vary for every woman. Some women spiral into
depression when none of the above are present in their lives. Other women
may experience all these things yet not suffer from serious depression.
Postnatal depression affects women from across the whole spectrum of
society—the poor, the middle class, the educated, the uneducated, the
disadvantaged and the wealthy.

What are the symptoms of serious postnatal


depression and anxiety?
Here are the recognised warning signs:

Feeling out of control.

Low confidence, low self-esteem—a sense of loss of self.

A continued inability to get anything done and the feeling of being a


prisoner unable to leave the house.

Feelings of frustration, anger and resentment which do not go away.


Women I talk to often mention feeling envious of women without
babies or women who have older children.

Alternatively, feelings of numbness.

Physical symptoms such as constant headaches, palpitations, sweaty


hands, sleeping difficulties (even when the baby is sleeping well) or
loss of appetite.

Constant feelings of guilt and shame.


A fear of going crazy.

Frightening delusions and fantasies about harming herself or her baby.

Panic attacks.

What can you do?


It is recognised that early detection of depression and anxiety followed up
by adequate intervention and treatment is a crucial factor in helping bring
about an effective and timely recovery. This is the reason women are now
routinely screened (asked a series of questions) about their wellbeing at
various times during their pregnancies, and after their births when they
visit child and family health centres (maternal and child health centres). As
not all women attend child and family health centres it is strongly
recommended that their midwives or family doctors undertake the same
screening procedures. Some women find the screening questions off-
putting and intrusive but there’s a pile of good research which validates the
screening as a way to detect distress and depression with the aim of
minimising the effects on the woman and her family. Health workers
conducting the screening should be trained to ask the questions in a
sympathetic and kindly manner.

If you miss out on the screening or start having distressing symptoms


sometime after the screening it is important not to try to carry on in the
hope that it will all go away. The first step is to tell someone. Discuss your
feelings with your child and family health nurse, your family doctor or
staff at your local community health centre. If you feel you do not get the
help you need from the first person you go to, try someone else. The right
health professional will:

Accept you the way you are and not try to ‘jolly’ you along.

Respect your confidence.

Let you express exactly how you feel.

Help you with any baby sleeping, crying or feeding difficulties or put
you in touch with someone who can.
Give you all the options available to you in the area where you live—
there is no single avenue of help that suits everyone, so you need to
know what’s available and how it will help.

Options for help


Getting sympathetic one-to-one counselling from a skilled health
professional who can help you help yourself is a vital first step. Self-
help ideas are things like learning to nurture yourself, learning how to
take a break and setting long-term and short-term goals. With the help
of the counsellor you can slowly regain a sense of self and start to take
control of your life again.

Many women find joining a postnatal support group where they can
talk to other women in confidence who are having the same experience
helps a great deal.

Reading books on the subject is helpful for you and your partner. Those
mentioned at the end of this chapter provide guides for self help.

Your partner requires support and information too. Men often try to
solve the problem quickly but end up feeling unappreciated and
depressed as well. Your partner needs to understand what you are going
through is not his fault and the power to fix the problem does not lie
with him. Listening, accepting how you feel and supporting whichever
road to recovery you are taking are ways he can help as well as sharing
the tasks of caring for the baby and running the home.

At times psychiatric help and drug therapy is appropriate. Some women


may not like this idea, but psychiatrists skilled in the area do not load
women up with unnecessary medication and in fact often do not
medicate at all after consultation. Medication takes the edges off the
symptoms, but is not effective as a quick fix on its own and should
always be used in conjunction with counselling and the other supports
mentioned above.

Recovery is slow and takes two to twelve months, sometimes longer. A lot
of patience is needed from you and your partner as well as commitment
from your health worker because time is part of the recovery process.
Although recovery can take a while, the result is positive for most women.

Obviously, given a choice no one would choose to suffer from what is


known as postnatal depression but many women (and men) acknowledge
that in hindsight positive things do come from the experience. By working
through the pain of depression they learn more about themselves and about
relating to others which has the potential to give a new, positive dimension
to their lives.

Postpartum thyroiditis
Occasionally, the symptoms of postnatal depression are confused with a
condition known as thyroiditis, inflammation of the thyroid gland. This
condition develops in 5–10 per cent of women within the first twelve
months after birth. The exact cause is unknown, but it is thought to occur
because during pregnancy the immune function is suppressed to prevent
antibodies that might harm the developing baby. After birth the immune
system rebounds and overproduces antibodies that combat not only
infections but the body’s glands and organs. The thyroid is one of the
glands that may be targeted, causing inflammation and hormone levels to
rise or fall.

Hyperthyroid phase: The hormone level rises, which can cause weight
loss, loss of concentration, tremors, palpitations, feeling hot and tired,
nervousness and insomnia.

Hypothyroid phase: After the overactive stage, the thyroid gland may
be unable to make enough thyroid hormone. This stage can begin
between the third and eighth month and last for up to eight months.
Symptoms here include unexplained weight gain, feeling cold,
depression and tiredness. Hypothyroidism is often misdiagnosed as
postnatal depression. Hormone levels can rise and fall, so symptoms
may swing between the two phases

Diagnosis is by blood test, and thyroid function should always be checked


when a woman reports any of the above symptoms following childbirth.
For more information visit www.thyroid.org.au or call Thyroid Australia
on (03) 9888 2588.
Sex
Despite the fact we live in a time when every bodily function, sexual or
otherwise, is openly discussed, analysed, advertised, videoed, filmed or
written about, sex between couples in long-term relationships remains a
big secret especially in relation to what actually happens after childbirth.

For decades we have had broad information about sex after birth, delivered
in bland language with a certain amount of coyness but there’s been a
paucity of honest, in-depth, first-hand confessions about the reality of
getting together again after the baby comes.

While the matter of sex came up from time to time when I talked to
mothers it was a long way from being the leading topic.

So, I decided that I would spark up this section by including some


information from the father’s perspective. The bloke’s perspective has,
historically in general baby/breastfeeding books, been brushed aside with
the all-encompassing advice that ‘practical help for mother is probably
going to help her feel more like having sex than watching an erotic DVD
will’. While there is truth in this there is far more involved in sex after
childbirth than the delegation of housework.

First some general information:


Some literature suggests it is normal for women to feel wildly sexual as a
natural progression of birth and breastfeeding. A number of women do feel
like this but many don’t. And, of course, many couples have no problems
at all—nevertheless I think the following information will be helpful as it’s
easy to think you are abnormal in some way if your sexual life is not
sailing smoothly.

You may be surprised to find out that surveys show the


following:
1. The arrival of a baby tends to change a couple’s sex life in ways that are
seen as negative. Resuming sex at six weeks is not the reality for most.
Many couples don’t have sex for up to six months after the birth; a lot
of couples have sex much less frequently than before the pregnancy for
a year, or longer—sometimes much longer—after the birth; at least half
of all women are less interested in sex after the birth than they were
before the pregnancy and this may last for six to twelve months or
longer—again, sometimes much longer. Often, though, this gives way
to a new depth of sexuality and, for women, greater ease in having
orgasms than before the birth.

2. Couples who pick up where they left off are the exception rather than
the rule. This is as much about what’s going on inside new parents’
heads, particularly mothers’ heads, as it is about the aftermath of birth,
fatigue and breastfeeding.

Reasons why sex might be off the agenda following


birth

From the mother’s perspective


Obviously, first up, discomfort following the birth especially if the birth
was long and difficult. Sutures following a tear or episiotomy,
haemorrhoids or the after-effects of a caesarean section are all going to
influence how a woman feels about having sex.

Breastfeeding: Data about how breastfeeding affects women’s sexuality


is conflicting. Some women report enjoying sex in a whole new way
while they are breastfeeding and others experience a decrease in libido
until they wean or menstruate again. Oestrogen levels are low while
you are breastfeeding so the chance of the vaginal wall becoming
thinner, less elastic and drier is likely, which can make penetration
uncomfortable, even painful.

There’s also another aspect to this: Breastfeeding is a sensual activity


once any early problems are solved. Some women find that their
physical and emotional needs for intimacy are met by the closeness
breastfeeding brings and don’t feel the need for anything else at this
time in their lives.

I’m unaware of any research that shows that women who wean soon
after birth necessarily feel more like sex than breastfeeding women. As
far as I know, the range of sexual feelings and experiences amongst
mothers who have weaned is similar to those who breastfeed. I suspect
there might be times when breastfeeding is a good excuse for not
having sex because women don’t feel like it for other reasons.

The weirdness of what happened ‘down there’: For many women


there’s the fear of the unknown, and an understandable reluctance to
have sex when it feels like their nether regions have been completely
re-arranged. It can be helpful to have a look with a mirror and gently
rotate two fingers in your vagina to give you reassurance all is as it
should be and an idea of any tender spots.

Exhaustion is a common state of affairs, not just for six weeks after the
birth but on and off for the first three labour-intensive years, especially
if there are a couple of small children under three. Many women
complain of having to give so much they have nothing left at the end of
the day when sex just seems like another demand that’s not much
different from cooking the dinner.

Interruptions: Babies (and toddlers) are unpredictable about their


waking, sleeping and eating habits and it takes an effort to use the time
you might have for sex when you’d sooner sleep or slump in front of
the TV.

Sharing a bed or sharing a room with a third person also takes time for
many couples to get used to (some never do).

Some women are embarrassed by their bodies after giving birth.


Everything from breasts to vagina seems to leak or flop which gets in
the way of sex both physically and mentally.

From the father’s perspective


A small number of men are so traumatised by witnessing the birth they
cannot relate sexually to their partners for some time.

A small number of men are put off by the change in their partner’s body
(others love the new ‘voluptuousness’). They may find being drenched
by breastmilk off-putting (others find it sexually stimulating).

Exhaustion is also a factor for men.


Some men have a real problem sharing the bed, even the room, with
babies or toddlers or children. And baby monitors can be real turn-offs.

Men, however, don’t have the rigours of birth and its aftermath, the
closeness of breastfeeding or, usually, the complete absorption in the
baby to the exclusion of everything else in their lives, to get in the way
of having sex.

Some men find sexual rejection a personal rejection and if it goes on for
a long time may switch off and stop initiating sex.

Overall—and I know there are many variations on this—men find


sexual abstinence for any length of time more of a problem than women
do. Without the physical and emotional connection of sex they tend to
feel neglected and sidelined.

What to do, what to do, what to do?

Suggestions (some of which will appeal, some of which may


make you hold up your hands in horror):
Accept early abstinence—depending on the birth, the baby, the
breastfeeding, the levels of exhaustion, the support that’s around and
the temperaments of the parents, this may be for up to six months.

Sorry to bang on about it yet again, but reliable practical help from their
partners does raise women’s libidos. The workload of women has been
officially linked to the declining fertility rate in Australia (and other
developed countries as well).

Communication is crucial. If communication was good before the baby


arrived it is likely to remain good or re-establish in time. If
communication was poor, solving any of the problems babies bring,
sexual or otherwise, is much more difficult.

Start slowly with no pressure. Massages, cuddling and body contact


without penetrative sex brings closeness.

We are so primed to think of sex as a spontaneous earth-shattering


event that it’s hard to come to terms with organising time for sex the
way we organise other parts of our lives. But this is what often has to
happen to get sex back again. And it doesn’t have to be prolonged,
earth-shattering sex. Initially, good enough sex is better than no sex for
a positive, emotional connection. Plan ahead and try to remove as many
barriers to the event as you can. Turn off the TV.

Researchers have found that the urge to have sex is not necessarily
preceded by feeling aroused. Rather, there are times when arousal and
interest in sex follows having it. In other words, do it even if you don’t
feel like it. Women, especially, should think about taking the plunge
when they feel physically okay even if their heads are telling them
something else. There is, I think, some similarity between this and
resuming exercise after a break. There’s that mental hurdle to cross
beforehand but when you do it you feel great and wonder why it took so
long.

At some stage in the first year a mutually agreeable arrangement has to


be made in relation to babies and toddlers sharing rooms and beds as
these are potential sources of disharmony and sexual discontent. One
parent may embrace the bed-sharing arrangement to avoid facing the
sex issue.

When one or both of you are chronically unhappy, marriage guidance


or family therapy helps. A dramatic change in the sexual relationship
which is not resolved in the first year after the birth may be a sign the
relationship has deteriorated with both of you suffering guilt and anger
over a variety of things.

Ongoing lack of interest in sex can be a sign of depression in some


women (along with other signs and symptoms, see chapter 16) and in
some men too.

Women should always seek advice if pain is still experienced deep


inside or anywhere around the vagina after six months or later.

If your sex life is causing problems in your relationship get help from a
third party. The longer you wait the harder it is to change anything and
it is not worth living in sexual frustration and misery for years or ending
a relationship that could be successful.
Ask your child and family health nurse or family doctor for information
about sexual counselling, marriage guidance or family therapy. Contacting
a women’s health nurse through a local community health centre is another
option. Alternatively, Family Planning Clinics can help.

Contraception
If you wish to space your children over a period of time you do need to
think about contraception soon after the birth if you are having a sexual
relationship. Here is a brief rundown of the most common family planning
methods. This is not intended as a thorough guide, rather to let you know
what’s available. You will need much more detailed information on the
various methods before use if you are unfamiliar with them, particularly
the newer contraceptives. Contraceptive advice and written information is
available from your doctor, a women’s health nurse (often located at
community health centres), the Family Planning Association or a Natural
Family Planning Centre. The Family Planning Healthline is 1300 65 88 86.

Barrier methods
Condoms and spermicide: These are particularly useful in the early
weeks and while your baby is being breastfed.

Diaphragms: Do need refitting. Wait at least six weeks before refitting,


then have the size checked again after three months. Diaphragms must
be left in place in the vagina for eight hours after having sex.

The female condom: Is now available in Australia. The female


condom is a thin, soft, clear plastic condom that fits inside the vagina
with a flexible ring at each end to keep it in place. The female condom
is comparable to the male condom as a barrier method of contraception
and is more effective than other methods, for example the diaphragm.
The female condom cannot be used at the same time as a male condom
because if they are used together the female condom could slip out of
place or tear and/or the male condom could come off.

Natural methods
Exclusive breastfeeding: This means breastfeeding without the use of
dummies, bottles or any other food. If you are breastfeeding in this way
it is reliable contraception as long as you have not started to menstruate,
you feed frequently and your baby is fed at night. Only a small chance
of conceiving is possible if you follow these guidelines, but if another
pregnancy would cause you problems, other contraception is advisable.
If you do use breastfeeding as a contraceptive you are at risk of
conceiving once you menstruate, once your baby sleeps through the
night or once you start her on formula or food from a spoon.

Abstinence: Abstinence until breastfeeding finishes or until conception


is planned is probably practised far more than anyone realises.
Abstinence means no penis-in-vagina sex—it does not mean no sex at
all. Kissing, touching, oral sex and cuddling are all ways of showing
affection.

Withdrawal: Withdrawal means the penis is withdrawn before


ejaculation occurs. Withdrawal is not at all reliable but is cheap and
readily available.

Rhythm, temperature or mucus method: A combination of all three


is the most reliable. The aim of these methods is to know when
ovulation is likely to occur and avoid having sex at these times. If this is
your choice for contraception, you and your partner need to attend a
Natural Family Planning Centre which specialises in the practice.

Hormones
The mini pill: The mini pill is a small dose of progesterone which is
not harmful to your baby and should not interfere with breastfeeding.
Some women who are breastfeeding report that when they take the mini
pill their babies refuse the breast and/or there is less milk. If you find
you have difficulties breastfeeding or with excessive bleeding, changing
to another brand of the mini pill sometimes helps. If not, other
contraception has to be arranged.

The mini pill works by thickening the mucus around the cervix, which
makes it difficult for sperm to penetrate. It is a very satisfactory form of
contraception when combined with the added protection of
breastfeeding.

If you wean or if you are only breastfeeding once or twice every


twenty-four hours, you need to think about other contraception. It’s safe
to take the combined pill (see below) and keep breastfeeding once or
twice a day, although the oestrogen in the combined pill decreases the
milk supply.

The mini pill’s contraceptive effect is best between three and twenty-
one hours, so try to avoid having sex for three hours after taking it or
within three hours of the pill being due. Therefore, the best time to take
it each day is midday or very early in the evening. Make sure it’s the
same time each day.

The combined pill: The combined pill, known as ‘the pill’, consists of
both oestrogen and progesterone and stops ovulation. It is not
recommended for women who are breastfeeding, not because the drug
harms the baby, but because the action of the oestrogen interferes with
the milk supply. If you wean and wish to take the combined pill, start
straight away. You do not have to wait until you menstruate. Diarrhoea,
vomiting and some antibiotics can affect the pill’s absorption, so extra
precautions might be needed.

The contraceptive injection (DMPA): This is a chemical similar to


progesterone. Each injection protects you from pregnancy for twelve
weeks. The first injection is best given five to six weeks after birth. It is
safe to use DMPA when you are breastfeeding—it does not affect the
quantity or quality of the breastmilk. The main side effect from DMPA
is irregular bleeding, usually not heavy. Some women also experience
weight gain, headaches or depression. It is a very effective form of
contraception.

Implanon: Implanon is a small plastic rod containing progestogen


which is inserted just underneath the skin of the upper inner arm. It
provides protection against pregnancy for the three years it is left in
place. It is a very effective method of stopping pregnancy. The most
common side effect is irregular bleeding, which can vary from no
bleeding at all to troublesome frequent bleeding. A small number of
women experience headaches, weight gain and breast symptoms. It is
safe to use while breastfeeding. You can have implanon inserted at your
nearest Family Planning Clinic or by a family doctor who has been
trained in inserting the device.

Intra uterine device (IUD)


IUDs are an effective method of contraception and suitable for some
women. An IUD can be fitted by your doctor eight to ten weeks after birth.
IUDs do not affect lactation, but there is a slight risk of damage to the
womb if a woman is breastfeeding.

Sterilisation
Sterilisation of either father or mother is not usually recommended until
the youngest baby is twelve months old. Making such a decision before
twelve months is often influenced by a crisis, emotional stress or a lifestyle
change. Many people feel differently a year later. Sterilisation of a woman
is by tubal ligation and for a man, a vasectomy. These procedures can be
reversed but they should be considered permanent contraception.

Returning to paid work and childcare


Many women now work outside the home when their children are young
for a variety of reasons, the main ones being:

They have no choice, owing to relationship problems or financial need.

They believe they have no choice because of social and economic


pressure related to a high standard of living that has come to be seen as
the norm over the last fifty years.

Paid work brings self-fulfilment and career opportunities. It is unfair


that men have unquestioned access to career and family while women
have always had to choose. Most professions are structured so a
woman’s advancement abruptly takes a plunge if she takes time out to
have babies and then spends three or four years at home with them. A
small number of couples are now arranging their professional working
lives so one parent is always at home with the baby. And a tiny number
of couples are reversing roles.

It is difficult for women (or men) to have to depend on another person’s


income.

Life at home caring for babies and small children is often lonely
because of the way our society is structured. It can be depressing
because full-time care of young children at home by their mothers is
over-idealised and under-valued, making women at home feel that their
work is worthless.

A combination of the above factors is involved for many women. In an


ideal world, we would all do what suits us best. There are women in the
paid workforce who would sooner not be there and there are women who
are at home who would love to go back to their other job.

The main solution offered in Australia for these dilemmas of our times is
childcare, and a diverse range of childcare provisions have increased
dramatically in the last couple of decades. Informal childcare undertaken
by friends, relatives and babysitters has always been around and still is, but
services that range from nannies who care for babies in their homes, long
daycare nurseries and home-based care are now available for most
families. Despite difficulties finding places in suitable geographic areas
and the financial burden involved, the majority of parents seeking
childcare usually find it.

Childcare has been viewed through rose-coloured glasses for quite some
time. A growing social, emotional and economic investment in childcare
means that we all want it to be all right so the benefits have been
emphasised.

The benefits centre around the right of women to have the same access to
careers and economic security as men, and the social benefits to the
children—many of whom enjoy the interaction with other children. Some
research shows that long daycare experience helps children to become self-
reliant, to learn to share and co-operate and have a larger view of the
world. In families where there are extreme social problems, long daycare
is a vital way of relieving parent stress and keeping the family unit
together.
The negatives have been suppressed due to fear of making parents feel
guilty and because of the seemingly insurmountable difficulties of other
options being made available in this country so parents can combine
parenthood with employment. The biggest negative impact is on babies
and toddlers who spend long hours in daycare under the age of two.

Concerns about long daycare for children under three have been raised by
a number of people such as psychologists Penelope Leach and Steve
Biddulph. Two respected researchers, Edward Zigler from Yale University
and Jay Belsky from the Pennsylvania State University, both initially
staunch proponents of childcare, reversed their positions on long daycare
after closely observing long daycare experiences of children under two for
over a decade. Negatives centre around the lack of one-on-one care by an
adult who has a parent-like commitment to the baby or toddler, the
increased possibility of a deprived childhood in a place where there is no
privacy, no escape, no place of one’s own and a 30 per cent increase in
childhood illnesses.

It is still too early to know whether children who spend the first two years
of their lives in institutional long daycare will end up with more problems,
social or otherwise, than those cared for at home. Chances are, most will
not, nor should the prospect of this possibility be used to scare the wits out
of parents. Until we know more, I see the main issue being about the
quality of life children experience at this time in their lives, which in long
daycare centres is far from ideal. Parents themselves often admit this, as do
many of the staff who work at the centres. Prospective parents need to be
fully informed so they are in a position to make the best decisions for
themselves and their babies. Blanket approval and bland reassurances
about childcare in the first two or three years are not particularly helpful.
Parents who have no other choice but to use long daycare should be aware
of the negatives so they can lessen their impact as much as possible.

Many parents do have other options which they may not even consider if
well-meaning health professionals keep telling them long daycare is as
good as or even better than care at home.

By planning ahead it’s often possible to work out ways to minimise long
daycare for children under two.

Here are some ideas:


Lifestyle expenses can often be arranged to allow for one parent to be at
home for twelve to eighteen months.

Part-time work should be negotiated whenever possible.

Don’t assume long daycare for nine hours a day, five days a week is the
only option if finances dictate an early return to paid work. Sometimes
parents can arrange their work so some of the care can be shared
between them. If there is a choice between three days in long daycare
and care spread between daycare, grandma and father, choose the latter.

One-on-one care at home is preferable to long daycare, so if this option


is affordable, employ a nanny. Some parents find sharing a nanny
between two families is a good compromise.

Whenever possible, be prepared to change arrangements or find other


care any time things are not working out.

If the need to return to employment is based on career opportunities and


self-fulfilment, rather than a financial necessity, try to hold off full-time
work for eighteen months. It may be unfair that it is usually the mother
who has to make this choice, but the trade-off in terms of peace of mind
and the child’s quality of life is worth it.

Getting organised
If you are returning to paid work some time in your baby’s first two years,
it is important to lay the groundwork for a smooth operation. Finding good
quality childcare is a top priority and should be organised as soon as your
pregnancy is confirmed.

Childcare services available


Childcare services range from nannies who will care for your child in your
home, private daycare nurseries, government subsidised daycare nurseries
and private or council supervised home-based services (Family Day Care).
Some parents make private arrangements with a babysitter who may be
untrained but reliable and caring.
When you are choosing, be guided by the cost, the caregiver’s ability to be
warm and affectionate, the safety and cleanliness of the surroundings, the
number of babies or children per caregiver and the caregiver’s
qualifications. Check what arrangements are made if the caregiver is sick
and whether the same person will be there most of the time to care for your
baby.

Try to arrange several times when you and your baby can be with the
caregiver before you go back to work.

See chapter 1 for more information on finding care and government


assistance.

Problem times
Babies and toddlers have lots of minor illnesses, especially when they are
in care with other children. As they grow older this is less frequent, but it
is very common in the first two years.

Mothers in paid employment do get very tired, as few ever seem to get
enough help to manage two jobs, either from their partners or their
employers.

So, as well as arranging childcare, try and establish a network of friends


and family who are prepared to help out in times of emergency.

Have a good talk with your partner so you can make definite arrangements
about sharing tasks—for example, picking up and delivering your baby to
her carer’s, getting up at night, sharing care when your baby is sick and
sharing the housework evenly.

Childcare when one parent is at home


The impression that childcare has untold benefits and no disadvantages has
been so widely accepted that many parents have come to believe that even
if childcare is not needed for paid work reasons, babies and toddlers
should be in childcare anyway for ‘socialising’. If you are concerned about
this be assured that, contrary to what everyone would like to believe,
babies and toddlers are not well adapted for social groups. While they are
fascinated by other babies and toddlers they are far too young to spend
long hours every day socialising. The normal social interaction that goes
on between families and friends is all the socialising they need. By age two
or three (depending on the child) most children are ready for some limited
time in a group setting for educational and social purposes.

This is not to say that children under three cannot be left for short periods
in group care or with other caring adults. Parents, especially mothers, need
a break and time and space to attend to their own needs. Babies and
toddlers often enjoy such a change too but if they don’t, are unlikely to
suffer when they are not left for long periods.

Sudden unexpected death in infancy


(SUDI)
Sudden infant death in infancy is something none of us like to think about
but we do; naturally, the time we think about it the most is when our
children are babies. Because of my work I am very much aware that
parents worry about SUDI as the subject is frequently mentioned when I
talk to them. I also come into contact with families who have suffered the
shocking event that is SUDI and as I write I am thinking of them and the
pain and grief they suffered and are still suffering.

It is normal to think about SUDI after the birth of your baby and at times
during the first year or two. It seems at every age and stage of
development there is something there to potentially cast a shadow over the
joy children bring. Certainly it is hard to find a parallel for the sudden and
unexpected death of a healthy baby, but as the years go by there is the fear
of ‘stranger danger’ and the adolescent years bring the worries of car
accidents and misuse of drugs and alcohol. These worries are part of being
a parent which we tend to be unaware of until we have a baby. Accepting
they exist, taking whatever sensible precautions we can and getting on
with life is also part of learning to be a parent.

If you find yourself thinking about SUDI, it’s better to talk about it with
your partner, family, friends or health worker rather than keeping
apprehensive thoughts to yourself.
FOR MORE INFORMATION
Chapter 1: Preparing for Parenthood

Chapter 11: Daily Care (SUDI)

Chapter 15: The Crying Baby (effect on relationship; anger and feelings of depression)

Chapter 18: Feeding Your Baby (paid work and breastfeeding)

Chapter 22: For Parents (paid work and night waking; travelling with your baby)

Chapter 32: Becoming a Toddler

FURTHER READING
Beating the Blues: A Self-help Approach to Overcoming Depression, Susan Tanner & Jillian Ball,
Australia, 1999. (Recommended for its sympathetic, practical advice.)

Postnatal Depression: Families in Turmoil, Lara Bishop, Halstead Press, Australia, 1999.

From Here to Paternity: A User’s Manual for Early Fatherhood, Sacha Molitorisz, Pan
Macmillan Australia, 2007; chapter 16, ‘Sex after childbirth . . . three’s a crowd’.
Part II:
3–6 Months
Chapters:
17. Equipment

18. Feeding Your Baby

19. Common Worries and Queries

20. Growth and Development

21. Safety

22. For Parents

{ Return to Table of contents }


17

Equipment
Part II | Contents | Next chapter
Eating equipment
Between four and six months your baby may start eating food from a
spoon. Any unbreakable plate and spoon will do, but you might feel like
choosing a special baby set from the wide selection available. Don’t waste
money on sets that include a host of things you don’t need. One plate and
one spoon is fine. Training system cups that offer a teat, a straw and a
spout are a needless expense at this stage. Wait until your baby can use a
straw or a spout, then buy whichever one she uses. Buying the three
systems is unnecessary, especially when one is a teat—if you’re bottle
feeding you already have one and if you’re breastfeeding you may never
use it.

Walkers
A baby walker is a device on a frame with a seat that allows a baby who
can sit alone to propel herself around using her feet and toes.

Not only is a baby walker a non-essential item, it is inherently dangerous.


Overwhelming evidence relating to injuries strongly suggests walkers
should be prohibited. Baby walkers are banned in Canada. There are
ongoing attempts to ban them here as well however they are still available
in Australia.

Walkers are very popular. They have wonderful entertainment value—


babies love them. And if a mother happens to have a baby (or twins) who
never sleeps, the time her baby is in the walker may be the only time she
gets to do other things.

But walkers do not teach babies to walk, nor do they provide them with
any sort of beneficial exercise. The use of baby walkers has no
developmental advantages for babies. The only positive feature they have
is their entertainment value and the fact that their use gives mothers a
break, which has to be weighed up against the following:

The extraordinary high walker-related injury toll. In Australia it is


estimated there are one thousand injuries per year suffered by babies
under twelve months while using walkers. The greatest number of
injuries are to the baby’s head; other injuries include fractures, burns
and scalds and broken front teeth. In the United States it is found that
up to 50 per cent of babies in walkers suffer a minor walker-related
injury. Up to 9 per cent of babies in walkers require medical attention
for a walker-related injury.

Injuries happen when walkers are used because their inherent design is
unstable and because babies are able to scoot around unsupervised at
great speed. In the process they trip over rugs, fall down stairs, jam
their fingers in doors, run into furniture and walls and have access to
hot objects and poisons.

Delays gross motor development (weight-bearing on flat feet, pulling


up onto furniture, ‘cruising’ and walking).

When babies are propped up in a walker their bodies tend to stiffen and
they push back with their feet, which encourages them to walk on their
toes and strengthens one group of muscles more than another. This
posture is not part of natural walking and can delay walking. Walkers
do not help babies develop their balance the way playing on the floor
does. In healthy babies the developmental delay is short-lived and much
more likely to occur when babies are left in walkers constantly for long
periods.

It is not easy keeping active babies happy all day, especially when they
don’t sleep much, and I sympathise wholeheartedly with mothers who find
using walkers preferable to listening to the grizzling. However, after
looking at the injury statistics and the very limited use a walker has, I
cannot recommend their use. If you never use one you won’t miss it. If you
decide to buy one here are some tips for safe use:

Look for the newer style walker built to the U.S. ASTM Standard F977,
which is safer and more stable. This still doesn’t prevents accidents
mentioned above, close supervision is crucial.

Never use the walker near steps or stairs.

Check the surfaces are flat with no objects that will cause the walker to
tip over.
Never carry the walker with the child in it.

If your baby is not bearing her own weight don’t let her use a walker.
Weight-bearing means that when you hold her standing with her feet
touching a hard surface she bears her weight well on both feet without
her legs buckling and bounces up and down. Most babies do this by six
months. A delay in weight-bearing is not a major problem in a healthy
baby who is developing normally, but use of a walker unnecessarily
delays weight-bearing even longer; in turn, this delays pulling up,
cruising around furniture and eventually walking.

Make sure that both the baby’s feet touch the floor.

Limit your baby’s use of the walker to thirty minutes a day to minimise
injury risks and to allow her the full range of movement she needs for
her optimum development.

Baby jumpers, battery-operated


swings and baby exercisers
Again, these products are non-essential items and have no advantages for
baby development. Nor have they any exercising benefit. They are
entertaining, offer babies new sensations and give mothers the opportunity
for a break, which is never to be sneezed at. Unlike baby walkers their use
is self-limiting as babies tire of them in a fairly short period, the risk of
injury is minimal and development unaffected when used for healthy full-
term babies. They are not recommended for premature babies or babies
who have been unwell, as these babies need playing with in ways that
enhance their development and this equipment does not offer the best
opportunity for this to happen.

Stairgates and safety gates


Once your baby starts to get mobile, gates are useful to block off doorways
of rooms such as kitchens, bathrooms, laundries and the tops and bottoms
of stairs. Mobility refers to crawling, which happens any time from five to
twelve months, walking, which starts between nine to nineteen months,
and any time your baby is in a baby walker. Make sure the gap between
the bars of safety gates is the same as that recommended for cots—no less
than 50mm (2 inches) or greater than 85mm (3 inches), so your baby’s
head or limbs don’t get stuck.

Playpens
Playpens seem to be something used more in the past when women had
fewer household aids and had to use playpens to keep their babies away
from danger while they worked.

Playpens can still have a use depending on your lifestyle and your baby
(lots of babies won’t stay in playpens very long). They can be an effective
barrier to dangerous areas and I’m sure we all know someone who irons in
the playpen while the baby has free run of the room. Playpens are useful to
put heaters in. At other times a playpen provides a handy space for
toddlers and young children to play in when they are playing with small
toys which need to be kept away from the baby. However, wait before you
buy—playpens are often bought and never used.

Portable cots
An optional item for families who travel a lot. Take care when buying as
portable cots are often badly designed and dangerous. Sadly a number of
babies have died following collapse of their cots. Cots that incorporate a
rotating lock mechanism which locks the top rails of the cot are the style
which cause concern. A number of brands of portable cots have been
banned while further enquiries are being made. Contact the Department of
Fair Trading or the Consumer Affairs Department in your state for further
information. You will find the number in the White Pages.

FOR MORE INFORMATION


Chapter 18: Feeding Your Baby

Chapter 24: Feeding Your Baby (tips for drinking from a cup)
18

Feeding Your Baby


Previous chapter | Contents | Next chapter
Starting new food
The optimum time to start solids changes every decade or so. In the 1920s
it was nine months, in the 1970s it was six weeks, in the 1980s it was three
to four months, in the 1990s it was four to six months, up until recently it
was six months, now it is back to four months again. Weird isn’t it? I must
admit I find it hard to take it all too seriously.

Previous recommendations were mostly based on whim, fashion and


whatever food was around at the time; now they are mostly based on
reliable research and greater scientific knowledge of nutrition, physiology,
food intolerance and allergy and baby development (we hope). However,
cynic that I am, it will be interesting to see what the story is in ten years’
time.

The latest change, back to four months, primarily arises in the world of
allergy where it is still not certain whether delaying food or certain foods
in infancy (as has been the practice for the last twenty-five years) is
helpful in allergy avoidance or if, in fact, it might be a factor in the
increase in allergic disease so marked in industrialised western countries.
In a position paper published by the Australasian Society of Clinical
Immunology and Allergy (ASCIA) on Allergy Prevention in Children it is
acknowledged that at this stage most allergy prevention strategies are
relatively crude with small or unconfirmed effects, and newer strategies
are still in experimental stages. Their recommendation is to delay
complementary foods (that is food other than milk) for four to six months
rather than waiting for six months. The paper also says that there is no
evidence that eliminating certain foods in babies’ diets after six months
has any preventative effects and may compromise their nutritional status.
On the other hand, avoidance of peanuts, other nuts and shellfish in high-
risk babies (babies born into atopic families) for the first two to four years
of life is not nutritionally harmful and may be beneficial.

Continuing to avoid these foods and the other recommended foods (see
later in this chapter) if your baby comes from a family at high risk for
allergy seems sensible and eliminates the fear of anaphylaxis (my
comment).
Allergy specialists now think that for low risk allergy babies—the majority
—there are advantages in starting food other than milk at four months
rather than waiting until six months as a possible way to halt the steady
increase in child food allergy. This is at odds with those in the world of
lactation who continue to believe exclusive breastfeeding for the first six
months is best. Many parents by now will be getting advice via their child
and family health nurse/maternal and child health nurse and some
paediatricians to offer baby food at four months. This confused state of
affairs is not very helpful to parents wanting to do the right thing in
relation to giving their babies food.

The Australasian Society of Clinical Immunology and Allergy has more


information on the issue here.

For more on this topic in Baby Love, see Allergies and food intolerance
later in chapter 18.

The World Health Organization (WHO) is still advising exclusive


breastfeeding for the first six months. Here is is a summary of their
reasons:

1. Studies show that by waiting until six months the risks of infections in
babies are reduced. (Surely this is more of an issue for vulnerable
babies living in areas where there are poor standards of living and low
food reserves.)

2. Babies’ digestive systems are more mature at six months. Their ability
to digest starches is limited until then.

3. By waiting until six months a range of food can be introduced relatively


quickly—as long as the baby is happy to eat it, of course—rather than
stringing the process out over weeks.

4. It is the opinion of WHO that there are no advantages in starting food


other than milk before six months.

5. The WHO (in contrast with the Australasian Society of Clinical


Immunology and Allergy and other significant global bodies) doesn’t
appear to have yet caught up with the latest regarding the concerns of
the rapidly rising rate of infant food allergy in developed countries (a
much bigger problem than in developing countries). Theirs is a one size
fits all approach to introducing food, an approach which doesn’t take
sufficient account of the special needs of some babies, for example,
starting food to complement a low breastmilk supply (see below). The
WHO recommendations also don’t allow for the different problems
experienced in the industrialised nations (the growing food allergy
problem) compared with economically developing nations (lack of
good food sources, contaminated water, unhygienic living). Having said
that I am aware that there are communities and families in Australia
that have similar problems to those in developing nations, nevertheless
for the majority of healthy full-term babies born in Australia current
research supports the benefits of exclusive breastmilk until four to six
months at which time solids should be offered. According to ASCIA
evidence of harm from introducing food to these babies earlier than six
months is weak and the earlier introduction of a variety of foods may
confer a benefit in relation to preventing food allergy.

Starting food to complement a low breastmilk supply

There are a number of women whose breastmilk diminishes around three


to four months so that there is not enough to match their babies’ growth
needs. This is shown by very slow weight gains or no weight gains over
four or five weeks (a very thin baby). Sometimes in this situation the
breastmilk supply does not increase despite increasing feeds, the mother
getting extra rest or by trying any of the other methods used to increase the
breastmilk (see chapter 6).

It is important for babies to be adequately nourished and in my opinion


there is nothing to be gained by leaving babies hungry until some specified
time because ‘breast is best’. As formula in a bottle can interfere with the
breastfeeding, and as these babies tend to refuse bottles, starting them on
cereal, fruit and vegies is a good way to give them extra food and still
maintain the breastfeeding, which may then continue for the whole of the
first year and even beyond.

If you do decide to delay giving food it is advisable to offer nutrition


other than milk by six months because:

1. Many babies’ appetites, nutritional and growth needs are no longer


satisfied by milk alone.

2. By six months, babies are starting to chew and bite with their gums.
Their hand to mouth co-ordination is more accurate and between six
and nine months they are starting to sit on their own, which makes
spoon feeding and finger food eating easier.

3. Developmentally and nutritionally it is advantageous for babies to be


exposed to other food and other ways of eating rather than being left
sucking on breast or bottle as their sole source of food unless there are
medical reasons for doing so. Breastmilk and formula will continue to
be a significant part of their diets but being encouraged to chew and eat
a range of other healthy food in the second six months is nutritionally
sound and helps towards avoiding the picky eating syndrome of the
toddler.

4. By six months many babies are interested in trying a range of food of


different consistencies. Not all of course, and obviously the idea is not
to attempt to force babies to try food when they are reluctant. Some
babies are not interested in solids until around twelve months. See Some
Normal Variations, later in chapter 18.

Food from a spoon is often advised for a range of reasons that have
nothing to do with nutrition or baby development. Here they are:

To encourage ‘sleeping through’ or because the baby suddenly


starts waking at night again around four to six months of age: Night
waking, sadly, is not often related to food. If it were, it would provide a
nice simple solution for sleep-deprived parents and hassled health
workers. Occasionally, in some specific circumstances, it does the trick,
but don’t be disappointed if you try it and nothing changes and
remember—sleep problems aren’t solved by trying to force babies to
eat or by searching for the elusive food they will eat.

To help prevent regurgitation: Starting food from a spoon rarely


makes any difference to the amount being regurgitated, or to crying
babies. If your baby is a big regurgitator you just end up with
technicolour vomit instead of white.

Curiosity: From three months on babies start to become aware of the


world around them and start to take a great interest in everyday
happenings, including what is going into their parents’ mouths at
mealtimes. Parents become agog with curiosity to see what their baby
will do with food of their own and can’t wait to try. However just
because babies show interest in the process doesn’t necessarily indicate
that they want the food themselves.

The baby starts biting, chewing and sucking on everything in sight


including her fingers and hands: From around three months babies’
hands are never out of their mouths. This is part of their sensory/motor
development and not a sign of needing food. Between three and six
months they all want to bite, chew and suck on anything going—again
this is part of their normal development, unrelated to food or eating, and
one way they learn about the world and all it contains.

Starting food early makes babies good eaters: I have never seen any
evidence that this is the case, including times in the past when babies
were started on solids at very young ages. Whether or not babies and
toddlers are good eaters seems to depend mostly on temperament, a bit
on the parents’ management of the eating behaviour and a degree of
luck.

‘Big’ babies need food earlier: Big babies thrive on breastmilk and
formula in the first four to six months the same as any other babies.

Pressure from relatives and friends: As previously noted, the


guidelines for starting solids change with every generation so it’s usual
for mothers to be inundated with a range of suggestions from their
nearest and dearest accompanied by what can sound like very valid
reasons—‘helping them to sleep at night’ and ‘it didn’t do you any
harm’ are the biggies—however, in light of current knowledge, four
months for most babies seems to be the earliest optimum time.

A note on tongue thrust:


As a young baby’s main way of obtaining food is by sucking, her tongue
has an up and down movement which is different to the movement of the
tongue when food from a spoon is eaten or fluid is drunk from a cup.
Sometimes when a spoon or a cup is put into a baby’s mouth her tongue
automatically pushes forward so food is pushed away. This is called the
tongue thrust reflex and much is made of this by some health professionals
in relation to giving babies new foods, often confusing mothers who may
be told to ‘wait until the tongue thrust is gone’, before starting food. I have
never found the tongue thrust information to be a particularly useful guide
as to starting food from a spoon. Tongue thrusting is an automatic
(unintentional) response in young babies but it is also at times intentional.
The average age for the tongue thrust reflex to modify/disappear is
between four and six months but some very young babies will eat from a
spoon without thrusting their tongues and some nine-month-old babies
deliberately thrust their tongues when offered food. From my observations
if a baby wants to eat she eats and if she doesn’t, she won’t.

Summing up: introduction of solids, what’s the best


age?
Despite the fact that at the time of writing (2013) we more or less have
consensus that four months is the best age to begin to offer food other than
milk, parents are still likely to be offered a range of conflicting opinions
about when to give baby her first teaspoon of food as gastroenterologists,
breastfeeding enthusiasts, some paediatricians, some food intolerance and
allergy specialists, naturopaths and others will almost certainly all have
their own ideas.

Parents who live in countries where no one gets enough to eat must find all
this agonising rather precious.

Until the guidelines become more definitive I think it’s up to parents to


decide. If you would like to get going at four months please do. I have
always organised the introduction of food in two sections—the first is a
beginning food ideas section followed by a second section which is a basic
plan to include a wide range of family food. On the other hand if you
would like to wait until your baby is six months so be it. Sometimes
there’s no decision to be made because your baby might refuse the food
until she is ready, see Some Normal Variations, later in chapter 18.

What equipment do you need to start your baby on her


first food?
A spoon without sharp edges. An unbreakable dish. You don’t have to
disinfect the dish and the spoon.

Something to grind up the food. If your baby doesn’t mind eating food
mashed with a fork, a fork is all you need. Many babies like their food
smooth to begin with—which means using something mechanical like a
Bamix, a hand blender or one of the small electric blenders specifically
designed for grinding up baby food.

Something to sit your baby in. When you start you may find it easier to
sit her on your lap. Once you’re in the swing of things a portable baby
chair is useful until your baby can manage a highchair or a chair
attached to a table (six to nine months).

Plenty of mopping-up cloths.

Which foods?
For those of you who need guidance or would like some home-cooking
ideas, refer to the recipe section at the back of this book.

Cereal: Cereal can be purchased at pharmacies or super markets or you


can make your own.

Rice cereal, baby porridge/baby muesli: Rice cereal has been the
starter cereal since the early 1980s, especially when given under six
months as, it was believed that the early introduction of wheat products
could lead to coeliac disease (an inability to absorb gluten, which is
found in wheat). Allergy researchers now believe that withholding
wheat products is not necessary and may in fact increase—not decrease
—the incidence of coeliac disease, so if you would like to try wheat-
based cereals instead of boring old rice cereal go ahead.

Cooked apples and pears: You may cook your own and puree them or
buy commercially prepared fruit for babies available in tins or jars.
Once you have determined your baby likes home-cooked fruit you can
prepare and freeze a quantity in the refrigerator. Make sure your baby is
going to eat the food first before going mad and filling up the freezer
with ice-cube trays of cooked fruit and vegies.

Cooked food in clean containers or jars of commercially prepared baby


food last up to three days in the fridge as long as you always scoop out
portions with a clean spoon.

Commercially prepared baby food is nutritionally sound and convenient


but it is more expensive, it has no advantages for babies (advertising
often implies it is superior), does not offer the range of tastes home-
prepared or fresh food does and when you prepare your baby’s food
yourself you know exactly what she’s getting.

Mashed ripe banana: Mashed or pureed banana with a little orange


juice is excellent first food for babies. It does give some babies hard
poo, so if this happens you may have to stop the banana for a while.
Banana also makes a strange poo sometimes so don’t panic if there are
a few dark red stringy bits in your baby’s poo after she eats banana—
it’s harmless.

Avocado: Mashed or blended avocado is very nutritious and enjoyed


by many babies. For some it is a little rich, which results in a bright
green vomit. If this happens wait a few weeks before trying again.

Yoghurt: Yoghurt is an excellent first food for babies, either on its own
or combined with fruit or vegetables. Yoghurt is far superior to custard,
which is best avoided. Custard is sweet and addictive so give it a miss
and try yoghurt instead. If your baby likes and tolerates yoghurt it’s a
wonderful, healthy convenience food. When served with fresh fruit it
makes a good meal on its own for older babies.

The healthiest yoghurt for babies is natural full-fat yoghurt. If you can’t
persuade your baby to eat the natural yoghurt try one of the fruit-
flavoured yoghurts without added sugar. Stay away from caramel and
honey yoghurts—they are sweet and addictive.

Lactose intolerant people who can’t drink milk can tolerate yoghurt
because the lactose is partially broken down by the bacteria which
cause the milk to thicken.

Commercial baby yoghurt desserts are a diluted version of the real


thing. They contain 26 per cent yoghurt which is then sterilised so the
yoghurt’s culture is destroyed. What’s left is mixed with fruit juice.
Those are fine to use as an alternative now and then or to start with, but
are not as nutritious as full-fat yoghurt.

Yoghurt does make a small number of babies regurgitate, gives a few a


red bottom and some a rash around their lips, so if any of these things
happen, stop, wait a month and try again.

Fruit gels: Fruit gels are simply pure fruit juice made into a jelly.
Babies enjoy them from time to time, especially in hot weather when
gels can be a useful way of getting extra fluid into babies who don’t
have bottles. You can make your own or use commercially prepared
gels.

Vegetables: I suggest potato, pumpkin and carrot to begin with as they


are all easy to cook and mash or make into a puree. You can try them
separately or combine them. Babies often like potato and pumpkin
together. Once you establish that your baby is going to be a vegie eater,
try the full range of vegies blended up together (broccoli, spinach,
sweet potato, zucchini and so on). You do not have to give one little bit
of a vegie weekly to test the result—it would take a year to try them all!

If your family eats meat, when your baby is around six months and
eating vegies well, try cooking a little mince meat or chicken and
blending it up with the vegies. Grate some cheese and stir it in as well.

Chicken soup is a regular item in the homes of many of the families I


see and traditionally in families of European descent this wonderful,
nourishing dish is offered as baby’s first food. Lucky babies.

How do you begin?


Pick one of the items from the list. Cereal is convenient and easy to
prepare until you work out how your baby takes to this new style of eating.
It’s a bit frustrating cooking up nutritious fruit and vegies for one little
teaspoon which initially may be spat back.

If you are using cereal, try one or two teaspoons mixed with 15–30ml of
expressed breastmilk, boiled water or prepared formula. Express your own
milk if it’s easy; if it’s difficult, select one of the other options.

Offer one or two teaspoons of food to your baby once a day until you have
some idea of how she takes to it. Try any time of the day that suits you.
For convenience, offer the food at the same time as the milk. If you offer
the food in between the milk feeds you will find you are offering your
baby food every two hours—this is time-consuming and unnecessary, but
remember there are no strict rules. If you find it suits you and your baby to
give the food from a spoon in between the breast or bottle, please do.

Milk-first or food-first?
There seems to be a push now to give babies their milk before their food
for the whole of the first twelve months. I can understand this being
advisable in certain situations, however I have a problem with
recommending it as a general ‘rule for all’ for the following reasons:

Six to twelve months is a critical learning period for eating food—as


opposed to sucking milk. Toddlers are renowned for fussy eating and in
my opinion this tendency is exacerbated by an over-emphasis on
sucking milk, particularly from bottles, in their second six months,
which then tends to flow into the toddler years. Excessive fluids
negatively alter older babies’ and toddlers’ appetites for healthy family
food. We now have an unacceptable level of tooth decay in the under-
fives. Paediatric dentists, confronted with the problem daily, lay the
blame squarely on the prolonged use of bottles—and sometimes
prolonged breastfeeding—into the toddler and pre-school years.

It simply doesn’t make sense to me to give a nine-month-old baby a big


bottle of milk—or a breastfeed—before offering her lunch. In my
experience it is unusual for healthy breastfed babies to significantly
reduce their breastfeeds because they are eating three meals a day. Most
carry on breastfeeding as they were prior to having food unless their
mothers purposefully start reducing the breastfeeds with the aim of
weaning around twelve months (see following page).

Babies drinking formula often reduce the amount of milk they drink
once they are eating well, which again in my opinion, is a good thing as
this means they are not as likely to get hooked on bottles throughout the
toddler years.

Babies who are reluctant to try food are not likely to be remotely
interested after a big breastfeed or bottle of milk.

Many breastfeeding women wish to wean—or to reduce the breastfeeds


to two or three every twenty-four hours—by twelve months, which I
think is a reasonable plan. The best way to do this is slowly over the
second six months in conjunction with offering their babies a wide
variety of family foods and water or milk from a cup.

I realise that this flies in the face of information from some breastfeeding
advisors so if you are breastfeeding and dedicated to feeding before food
please do so. If you are formula feeding I strongly advise offering the milk
after the meals.

Other situations where it is advisable to offer milk first:


When four-to-five month old babies are given extra food because there
is not quite enough breastmilk.

Fussy breastfed or formula-fed babies who are slow to gain weight,


especially if they are premature or low-weight babies or have medical
problems.

Breastfed babies who get badly constipated once they start eating food.
There are a few different ways to deal with this (see chapter 19) but
breastfeeding before the food until the baby’s body adjusts could be
helpful.

Initially your baby will probably want to suck when she’s hungry—that’s
what she’s used to. Offering her a spoon first may frustrate and annoy her.
You might like to offer one breast or half the bottle, try the food then give
her the other breast or the rest of the bottle.

Once spoon feeding is well under way most babies who enjoy food usually
like to eat first then finish off their meal with the breast or bottle, often
before having a nap. Sucking at the end of a meal is calming and
pleasurable for you both. It is also a nice time for a cuddle.

How to proceed
Sit your baby on your lap or in a portable chair. Take up a small amount of
food on the tip of the spoon and place it in her mouth, well back over her
tongue before emptying it, to encourage her to swallow. Expect some or all
of the food to come back out of her mouth when you first start. Take it
slowly, stay relaxed—food is fun, if a little messy.
If you have twins you might find it easier in the beginning to offer the food
to each baby separately to see how they take to it. Once it’s well under
way sit them in portable chairs and use one dish and one spoon and feed
them both at the same time unless there’s two of you around to do the job.
Babies quickly develop individual tastes so don’t be surprised to find one
baby’s eating style is different to the other’s.

The same guidelines apply to premature babies as full-term babies, but if


your baby was very premature you will probably find she is not ready to
start food from a spoon until she is around six to nine months.

It’s all experimental until you find out what your baby thinks of this new
way of eating.

If after a day or two it’s going down with a minimum of fuss, increase an
extra teaspoon of cereal every day or two up to a maximum of two
tablespoons. If you think your baby is interested but doesn’t like rice
cereal, try mixing some fruit with the cereal or try one of the other
suggested foods. When she is comfortably eating one to two tablespoons
of food every day, try a second meal after two weeks. Two or three weeks
later offer a third.

Never try to force the food if your baby doesn’t want it. If you have an
interested eater resist the temptation to try everything on the menu in three
days. Try a new food every two or three days.

A word about vegies


Vegies are wonderful. Vegie-eating babies make us all feel good, but I
would estimate about half of all babies won’t eat vegies, initially at least,
so don’t let it get you down if you have a non-vegie eater. She will be fine.
It’s best to stop cooking and offering them every day after a few weeks if
the vegie refusal looks like it’s here to stay because you will get angry and
your baby will get stressed. Just offer two meals a day or think of
something else for the third. A second round of cereal and fruit is fine;
babies don’t look for endless variety. Keep going back to vegies every
week or so because your baby might surprise you and suddenly lap them
up.
Some normal variations
It is difficult to be precise about food and babies. They all respond to food
in their own way and you must be guided by your baby. Wide variations
exist across the eating spectrum which have little to do with the mother’s
feeding techniques. Here are the main ones I observe:

Loves food, eats anything: Some babies just open up and down it
goes! Be careful not to overdo it if you have one like this. Three to four
tablespoons of food three times a day as well as the breast or bottle is
ample. As babies like this eat anything, they are just as happy with a
plate of vegies as anything else so it’s easy to give them a healthy diet
that won’t cause excessive weight gains.

Eats well initially then suddenly refuses: Don’t panic. Stop


completely and try again in a few weeks. Continue milk only for the
time being.

Complete refusal: If, after you try a few different things over a week
or two and you are getting nowhere, stop—try again in a few weeks.
Continue milk only for the time being.

Loves some things, refuses others: Give her what she likes even when
it is the same old boring things each day. Try offering different food
every few days but don’t get hung up about refusals. Avoid the
temptation to try sugary baby biscuits, flavoured custards and added
sugar to vary the diet. They are not needed.

Keeps refusing all food from a spoon indefinitely: About 20 per cent
of all babies are finger food babies who constantly refuse food until
they can feed themselves with their fingers. Parents find this frustrating,
but it’s their baby’s decision and respecting this is the only rational
approach. If you have a finger food baby, start to allow her two or three
pieces of food to suck herself any time from six months onwards. After
ten minutes call it quits until around the next mealtime. Sometimes
finger food gets eaten, sometimes it gets thrown around the room, but
healthy babies who eat like this thrive when left alone to get on with it
without a lot of agonising and soul-searching from the parents about the
five food groups and so on and so on. Offer the breast or bottle after the
food. Here are some finger food suggestions: steamed vegie sticks;
grated carrot or apple (because of choking risks do not give whole);
small pieces of ripe pawpaw, pear, rockmelon; pieces of home-made
rissoles; pieces of home-made salmon or tuna rissoles (after six
months); fingers of bread or toast (seedless); crusket biscuits; fingers of
cheese on toast.

No food at all for a long time: A number of very healthy thriving


breastfed babies have mothers with such an abundant milk supply that
they see no need to eat anything and end up exclusively breastfed for a
very long time. They often refuse most food until they are nine to
twelve months old. The issue of iron deficiency in babies who are
exclusively breastfed beyond six months has been raised in the last few
years. There is some evidence that 10 to 30 per cent of babies who are
exclusively breastfed after six months may become iron deficient.

Unfortunately, when babies are obviously thriving and look healthy, the
only way to monitor this is to take blood tests or give all babies in the
second six months who are exclusively breastfed iron supplements.
Because opinion is still divided over the age at which iron levels are
depleted in breastmilk and the usefulness of such strategies, I suggest
feeding on. Try your baby with food in a relaxed way. If you are
worried about the possibility of iron deficiency talk it over with your
child and family health nurse or paediatrician. If anyone’s advice puts
you in panic mode, seek a second opinion.

If your baby is not an avid eater, don’t be tempted to give food in a bottle
instead of off the spoon. Traditionally, parents from some cultures do give
fruit, vegies, yoghurt and soup from bottles with big holes cut in the teats.

Whilst recognising that generations of babies have grown into adults


where this has been the practice, it is not recommended for the following
reasons:

The baby has no control over the amount of food she is ‘drinking’. It
just glugs down and weight gains can become excessive.

Food in a bottle is not teaching your baby the skills she needs to learn
to eat in a socially acceptable way.

Sucking food from teats increases the chance of tooth decay, especially
when this way of eating goes on into the second year, which it often
does because it is very habit forming.

How do you know if the food causes a reaction or


doesn’t suit your baby?
It is not always easy to know when food is the cause of problems in babies.
Things like runny noses, loose poo, red cheeks, nappy rash, vomiting,
grizzling and unexpected night wakings often have nothing to do with diet.
If you are concerned, stop the food, wait a few weeks and try again.

The following things are stronger indications of possible problems:

Mountainous vomiting one or two hours after the food, especially if


your baby does not normally vomit much.

A sudden bout of loose poo which causes a red, burnt bottom. In older
babies who are eating chunkier food, recycled food in the poo is
normal.

Hives. (Food is a common cause of hives but not the only one—drugs
and infections also cause hives.)

Swelling and redness around the mouth soon after the food is eaten.

A red mottled rash covering the whole body appearing soon after the
food is eaten.

Seek advice if you are worried. A small number of babies need


supervised diets because of food allergy and food intolerance (see
chapter 18).

Here’s a guide to follow once your baby is eating well

(Offer up to two or more tablespoons three times a day)


Early
Breastfeed or bottle feed
morning

Mid-
Rice cereal with cooked fruit plus breast/bottle (‘breakfast’)
morning
Early
Mashed vegies (add meat and chicken after a week or two) plus breast/bottle (‘lunch’)
afternoon

Early Yoghurt and fruit or mashed banana, or try avocado/cottage cheese mashed or some nutritious chicken
evening soup plus breast/bottle (‘dinner’)

Late
Breastfeed or bottle feed (if needed)
evening

The guide above offers four breastfeeds a day. If you wish to breastfeed
more, continue in the way that suits you and your baby. Water in
between meals is optional. Bottles and teats do not need disinfecting after
the first six months.

Food allergies and food intolerance


An allergy is an over-reaction of the body’s immune system to a foreign
antibody, usually a protein. Allergic reactions are often caused by food
proteins, but may also be caused by proteins in medication, chemicals,
dust, smoke, insect bites, pet hair, pollutants or dust mite poo. Allergic
reactions may be immediate, within two hours, or delayed, happening up
to forty-eight hours after eating the food. Immediate reactions are more
likely to be due to food allergy, delayed reactions to food intolerance.

Some food allergy facts


The number of children experiencing allergic reactions to food is rising
in western society. About 4–6 per cent of babies, toddlers and
preschoolers now have true food allergy—egg, milk and peanut protein
being the most common. Other foods include the protein in wheat, fish,
soybean, nuts, sesame and berries.

Allergy and intolerance to food is more common in young children


because their immune system is not fully developed. Most children
grow out of their allergies before starting school—less than 1 per cent
of adults have food allergies, usually to peanuts, tree nuts and fish.

No one is too sure why there is an increase in food allergies, but it is


unlikely that it is due to food additives. Some experts think it is because
young children are exposed to a much greater range of foods than
previous generations were. Others think it may be because modern
living and medicine has so dramatically decreased the number of
infections in early childhood that instead of fighting off bacteria and
viruses, babies’ immune systems are now fighting off food proteins.
And, as mentioned previously, there is some thought that delaying
solids and restricting types of food in babies as has been past practice
may be a factor increasing the incidence of allergic disease rather than
delaying/preventing it. At the moment all these theories are speculative
rather than definitive.

Food allergy is strongly genetic. Babies who have one family member
with asthma or eczema have a 20–40 per cent higher risk of developing
food allergy; if there are two or more family members with allergies,
the risk increases to 50–80 per cent.

Allergic reactions
Non life-threatening reactions
Reactions may be immediate (two hours or less), or delayed (up to forty-
eight hours) after the food is ingested. Common allergic symptoms include
swelling around the eyes and mouth, flushing of the skin, rashes and hives.
Other symptoms include excessive mucus, abdominal cramps, diarrhoea
and vomiting.

Life-threatening reactions
A small number of older babies experience life-threatening reactions to
food, peanuts and egg being the most common. This is called anaphylactic
shock.

Signs and symptoms of anaphylactic shock—rapid onset


Noisy/difficult breathing, wheeziness.

Swelling of throat and tongue.

Hoarse voice.
Paleness, floppiness.

Loss of consciousness.

In some cases anaphylaxis is preceded by the non life-threatening reactions


described above. Most babies/toddlers who experience the lesser reaction
to food do not go on to have a life-threatening event but a small number
do, sometimes the next time the food is introduced.

Steps to follow for unexpected anaphylactic shock (when there


is no adrenalin in the home)
1. Dial 000. State that a baby is having an anaphylactic reaction and
requires rapid transport to hospital via an intensive care ambulance.
Give full address, phone number and postcode.

2. Lie the baby flat and raise her feet (if possible).

3. Remove the food from her mouth.

4. If she stops breathing, commence heart–lung resuscitation. N.B.: Be


prepared. Heart–lung resuscitation courses are available in your state
from the Royal Lifesaving Society, the Red Cross and St John
Ambulance. Single-page charts of basic resuscitation techniques are
available from children’s hospitals in all states. Pin one on the back of
the toilet door where you will have a constant reminder of what to do.

Tracking down the allergen


Non life-threatening reactions
It can be difficult working out if a rash, runny nose or swelling around
the mouth is due to food or a viral infection. During the first three years
when babies and toddlers are being introduced to food, many have mild
reactions which are not serious. It’s simply a matter of waiting a month
or two and trying again.

Toddlers who react to peanuts have a higher chance of reacting to egg,


milk or soy as well, although not always. As allergies develop over time
the reaction may not occur until a baby or toddler has eaten the food a
few times. And sometimes the food is fine in one form but not in
another, for example yoghurt may be tolerated when milk is not.

Laboratory tests are unreliable in diagnosing allergic reactions,


although a skin prick test can be a guide. Sometimes the results of
laboratory tests are used to inappropriately restrict diets in ways that
may not protect against the allergy and may put the toddler’s nutritional
status at risk. Alternative tests such as hair and saliva testing and
kinesiology are of no use—save your money.

The most reliable way to test for food allergy remains excluding the
food for a set period then re-introducing it—this is known as a food
challenge. A food challenge may be done on its own or in conjunction
with a laboratory test. A food challenge is not as simple as it sounds,
because milk, egg or peanut proteins are found in many foods.
Guidance from a dietitian, paediatrician or allergy specialist is
advisable to find out exactly what foods should be avoided and what
substitutes should be used in order to ensure a nutritionally adequate
diet.

Life-threatening reactions
Identifying the cause of anaphylaxis is obviously very important. Often
it appears to be self-evident (for example, it coincides with eating a
peanut butter sandwich or an egg), nevertheless you will need to discuss
it in detail with your doctor to exclude other conditions that can be
confused with anaphylaxis. This may be followed by allergy testing
(blood or skin prick) to help confirm or exclude all potential triggers.

Long-term management includes referral to an allergy specialist,


education on the avoidance of the trigger(s), which will include advice
from a paediatric allergy dietitian, and provision of an Anaphylaxis
Action Plan.

Minimising the risks of life-threatening allergic


reactions—general guidelines for babies and toddlers
Although the number of babies and toddlers experiencing anaphylaxis
triggered by food allergy is increasing, statistically the numbers remain
small. Most babies and toddlers tolerate a wide range of food without
disastrous consequences.

Because it is nutritionally advantageous for babies (in the second six


months) and toddlers to be offered a varied diet, it is not advisable to
strictly limit the diet of the general population because of the small
possibility of a severe reaction. A life-threatening reaction to food (or
medication, bee sting or anything else) is a horrifying event for parents.
However, there has to be a balance between protecting vulnerable children
while still ensuring that the vast majority of babies and toddlers do not
have their diets unnecessarily restricted—which can lead to its own
problems.

Here is a list of the latest specific food recommendations to


reduce the risk or severity of allergy diseases in high-risk
babies taken from the Australasian Society of Clinical
Immunology and Allergy’s position paper, August 2008:
High-risk babies can be identified by their family histories; that is by
the presence of allergies and asthma in their parents and siblings.

Dietary restrictions in pregnancy are not recommended for any women,


including those from families with high risks of allergies.

Breastfeeding is recommended for all babies because of the undisputed


multiple benefits of breastfeeding. The beneficial effects of exclusive
breastfeeding in relation to allergic disease remains uncertain however
current consensus recommends exclusive breastfeeding as first
choice, for at least the first four to six months, for children at high
risk of allergy.

It is no longer recommended that breastfeeding women avoid certain


foods while they are breastfeeding regardless of whether their babies
are at high risk of allergic disease.

If breastfeeding is not possible, high-risk babies may benefit from HA


formula (see chapter 7), however this is somewhat speculative (see
chapter 15). There is no evidence soy and goat’s milk formula reduces
food allergy risk and are not recommended.

Complementary foods should be delayed for at least four to six months.


Interestingly, the allergy preventative effect of this strategy has only
been demonstrated in high-risk and premature babies, not in the vast
majority of babies who have no risk of allergic disease.

There is no evidence that an elimination diet after the age of four to six
months provides a protective effect from allergic disease although this
needs additional information. In other words, eliminating dairy
products, eggs, fish, berries, soy and sesame products has been shown
to be of no benefit beyond six months.

On the other hand, avoidance of peanuts, nuts and shellfish in high-risk


babies (babies born into atopic families) for the first two to four years
of life is not nutritionally harmful and may be beneficial.

Food intolerance
Food intolerance is more common than food allergy. Food intolerance
describes an adverse reaction to chemicals in food. The chemicals may be
those that are naturally occurring or additives in processed food.

Food intolerance can occur at any age and reactions usually depend on the
amount of a particular food that has been eaten. A baby or toddler may
show no symptoms after eating the food in small doses or a one-off dose,
but may react after eating or drinking a larger amount following a buildup
of the chemical(s) over time.

Commonly recognised symptoms of intolerance are not that different from


allergy symptoms and include hives, rashes, itching, migraines, irritable
bowel, asthma, nasal congestion, abdominal cramps and diarrhoea,
lethargy and limb pains.

Diagnosing food intolerance can only be done by an elimination diet


followed by a food challenge. This takes a long time and involves very
restricted diets, a difficult feat for young children—not to mention their
parents. Results can be ambiguous—it is often hard to know whether a
reaction is due to the challenge or to chance.
A tricky business
The issue of allergy, food aversion and food intolerance becomes very
confused in relation to babies and toddlers because they can’t explain what
is troubling them. Many older babies and all toddlers at some time or
another suffer from the endless runny nose, the eternal cough, runny poo
and mysterious rashes. Toddlers also tend to behave in unpredictable ways,
eat like birds and poo like elephants—none of which are symptoms of
anything other than being a toddler.

To add to the confusion, research into the relationship between food and
common childhood ailments such as asthma, eczema and hay fever is
conflicting and the success of dietary restrictions to alleviate these
conditions varies tremendously between individuals. As these ailments
tend to come and go spontaneously it can be very hard to work out how
much of a part food plays compared to cigarette smoke, viral infections,
dust and air pollution, pollen, dust mites, the weather and animals.

When problems are suspected it’s important to get specialist help so that
you are not eliminating, or in the case of babies delaying, the introduction
of food unnecessarily.

Paid work and breastfeeding


Organising their return to the paid workforce and arranging the best care
possible for their babies is a concern for many women around this time.
Combining breastfeeding and paid work is part of this and many women
are keen to continue breastfeeding, but unfortunately often feel that
breastfeeding has to stop once paid work starts.

Because of this many women who intend returning to work during the first
six months often feel discouraged from starting breastfeeding in the first
place. Others think that even if they do start, it has to stop once paid work
starts.

Many women are also under the impression that they have to either
breastfeed or formula feed and that once formula is started they have to
wean. This is not the case; breastfeeding and formula feeding can be
combined. When you are unable to fully breastfeed, breastfeeding is great
for you and your baby whenever you are together, which will still be a
considerable amount of the time. Continuing part-time breastfeeding is
also a comfort for many women, who find that leaving their babies to go
back to work is a very emotional time.

On the following page is a guide so you can get organised before you start
work. It can be used for expressed breastmilk or formula or a combination
of both. If using formula use a cow’s milk-based formula labelled ‘suitable
from birth’.

Here is some information to help you continue breastfeeding after you go


back to your other job.

Get breastfeeding off to a good start


Try to delay returning to paid work until your baby is at least three months
old as this gives your baby and your body time to learn to work together to
get the milk flowing. It also gives you time to sort out feeding difficulties
and overcome any problems.

Planning
Most things in life work a little better with some planning (you may note
this seems to be my theme song). Combining paid work and breastfeeding
is no exception. In the early days learning to express is of great benefit.
You can get help with this from a midwife, a child and family health nurse
or an Australian Breastfeeding Association counsellor. Once you have the
idea practise as often as you can—it’s like any skill, the more you do it the
easier it becomes.

Approaches to breastfeeding and paid work vary depending on the age of


your baby and the hours of paid work involved, so working out a plan to
suit your particular needs well ahead of time is very useful. Your child and
family health nurse or Australian Breastfeeding Association counsellor can
help with this.
Week One

Time Monday Tuesday Wednesday Thursday Friday

6 am Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed


10 am Bottle feed Breastfeed Bottle feed Breastfeed Bottle feed

2 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

6 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

Week Two

Time Monday Tuesday Wednesday Thursday Friday

6 am Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed

2 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

6 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

Week Three

Time Monday Tuesday Wednesday Thursday Friday

6 am Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed

2 pm Bottle feed Breastfeed Bottle feed Breastfeed Bottle feed

6 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

Week Four

Time Monday Tuesday Wednesday Thursday Friday

6 am Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed

2 pm Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed

6 pm Breastfeed Breastfeed Breastfeed Breastfeed Breastfeed

A cup instead of a bottle has many advantages, especially for babies who
are reluctant to take bottles. This is possible at any age after four months,
but is easier with older babies who are also eating food from a spoon.
Starting a cup well before you go back to your other job means your baby
is used to it and makes life easier for your carer. Give small amounts
frequently throughout the day from a small cup.

Planning is important, but stay flexible as there is usually a period of trial


and error during the first month.
Here are the choices
Having your baby looked after at work and being able to feed her there is
the ideal way to combine breastfeeding and paid work. Unfortunately,
moves to make this option a reality are very slow, so work-based care is
only available to a limited number of women in Australia.

Apart from being able to go to your baby for feeds there are three other
options:

1. Replacing breastfeeds with expressed milk from a bottle when you are
not there.

2. Replacing breastfeeds with formula from a bottle when you are not
there.

3. Replacing breastfeeds with food from a spoon and a cup—a possibility


from six months onwards (See Starting new food in chapter 18).

Option 1
Once your breastfeeding is going well (six to nine weeks) you can replace
one of your breastfeeds with a bottle of expressed milk. You will need to
express 120–150ml, depending on the size of your baby and her appetite.
This amount increases quite quickly as your baby grows. By three months
she will need 150–210ml in each bottle. If your partner gives the
replacement bottle it leaves you free to express at the time of the missed
feed. Starting a regime of expressing and giving one bottle a day well
ahead of returning to your other job gives you a chance to learn how to
express and helps your baby get used to a bottle. Once you are in a routine
with one feed, add another so your baby has two bottles of expressed milk
and about four breastfeeds every twenty-four hours. Continue this schedule
after you return to work when the bottles of expressed milk are given by
your babysitter.

Ideally, to maintain your supply you should express once or twice at work,
store the milk in a clean container in a fridge and bring it home with you in
a cold storage pack. If it is not possible for you to do this, you will need to
express and store the milk during the time you are not at work. This can be
done after a feed, between feeds or any time your supply is abundant. If
there is neither the time nor facilities to express and store milk while you
are at work, you will still need to express once or twice a day for comfort
for a week or two until your breasts adjust to missing feeds. Unfortunately
in many workplaces the only room to do this in is the women’s toilet.

Problems arise with this option either because some women can’t express
or because the amount they are able to express starts to dwindle after being
back at work for a while. It’s important to remember an inability to express
does not mean you have a low supply; your baby will still get plenty when
she goes to the breast. Nevertheless, not being able to express much leads
you to option two.

Option 2
If you decide to use formula instead of breastmilk before you go back to
work it’s a good idea to start one bottle of formula a day, then to increase
the bottles slowly until your baby is having the number of bottles a day
that she will be having once you are back at work. If you are going back
full-time you need to start this about three or four weeks before you start
work in order to give your breasts time to adjust. The guide in chapter 18
will help you to organise this and can be used for expressed breastmilk or
formula or a combination of both.

If you are already back at work and the amount you are expressing is
diminishing, start making up the difference by leaving bottles of formula
with your carer as well as any expressed breastmilk you have.

In order to keep your milk flowing, give your baby extra feeds at
weekends and in the evenings. Try not to give any more formula than is
necessary when you are around to feed as an increase in formula can result
in a decrease in breastmilk. Ask your carer to give your baby her last bottle
well before you pick her up so she is ready to go straight to the breast as
soon as you both get home. A bottle of water will often keep your baby
happy until you arrive.

Option 3
Babies who start food from a spoon from six months and like it can have
food instead of the breast twice a day while you are at work once they are
eating well. Fluids such as expressed breastmilk or formula can be given
from a cup as well as water occasionally. The earliest, realistic age this is a
possibility is from about six months as food can only be introduced at the
baby’s pace and it takes about six weeks for most babies to learn to drink a
reasonable amount from a cup. If the time frame fits your return to paid
work it’s a much gentler option than forcing your baby to take a bottle.

FOR MORE INFORMATION


Chapter 7: Bottle Feeding Your Baby For the First Two Weeks (What’s in formula?; equipment;
care of bottles and teats)

Chapter 8: Breastfeeding Your Baby After the First Two Weeks (


how to express and store breastmilk; low supply; baby won’t take a bottle)

Chapter 14: Sleeping and Waking in the First Six Months (‘sleeping through’)

Chapter 15: The Crying Baby (reflux, heartburn and vomiting)

Chapter 16: For Parents (Tips for grandparents; conflicting advice)

Chapter 24: Feeding Your Baby


19

Common Worries and Queries


Previous chapter | Contents | Next chapter
Bathing
At some stage between three and six months your baby will grow out of
the baby bath and will need to be bathed in your bath. Moving into the big
bath goes smoothly for most babies who enjoy the added space and
freedom, but a few are not keen. If your baby is like this, take it slowly and
gently—bathing her in the baby bath in the big bath or perhaps sharing a
bath with her might help her get used to the idea.

Bathing babies in the big bath when they can’t sit on their own is not great
for adult backs, so if you have a back problem it may be worth investing in
a baby bath seat which provides support for your baby until she sits well
on her own. Never leave your baby unattended while she is in a baby bath
seat for any reason as babies have slipped out of them and drowned. If the
phone rings take her with you. If you are still using baby bath lotion and it
is a drain on your resources, stop using it as it is unnecessary. Avoid
bubble bath solutions as they do cause problems for some babies’ skin—
mild soap and water is fine.

Swimming
Parents often wonder when it is okay to take their baby swimming. Full-
term healthy babies can start going for a swim any time after three months.

A few guidelines follow:

Make sure your baby is well-protected from the sun (see chapter 11 for
more).

Cold water frightens babies, so test the water yourself first; it should be
comfortable.

Sadly, many of our cities’ beaches and natural pools are often polluted
so avoid them following heavy rain or if you have any concerns at all
about the cleanliness of the water.

Limit the time to thirty minutes or less to avoid sun damage and over-
chilling.

Inflatable tubes and water wings are not safety devices and do not
replace adult supervision. With babies all water activities should be on
a one-to-one basis with a responsible adult. Never leave your baby with
an older child.

Be aware that while water play and swimming lessons give babies and
toddlers confidence and enjoyment of water they do not give them skills
that prevent them from drowning even if they learn to float and dog
paddle from a young age.

Early childhood drowning prevention involves:


Effective, well-maintained fences around swimming pools: Evidence
shows that 50 per cent of fences are not properly maintained and that gates
are frequently left open and/or have faulty self-closing/locking
mechanisms.

Supervision: Lack of parental supervision has been identified as one of


the biggest causes of childhood drowning.

Swimming lessons: While teaching babies/toddlers/pre-schoolers to swim


is not a guarantee against drowning it is an important drowning prevention
strategy. When toddlers/children who have little or no experience of water
go under they panic and freeze. If they are used to how it feels being under
water they don’t panic and have more chance of helping themselves in
dangerous situations. Even a minute can make a dramatic difference.

Resuscitation: Prompt, effective resuscitation saves lives. Heart–lung


resuscitation courses are available in every state from the Royal Lifesaving
Society, the Red Cross and St John Ambulance. Parents (and pool owners)
who learn and regularly update resuscitation skills are taking an important
step in the prevention of death from drowning in the under-fives.
Resuscitation along with the fencing of swimming pools is regarded by
many experts to be the two highest drowning preventative measures in this
age group.

Formal baby swimming classes


Nowadays it is widely accepted that while the first two to three years is an
ideal time for babies and toddlers to learn to relax and be comfortable in
the water and ultimately to swim it must be done gently, by degrees, at
their own pace.

What is the optimum age to learn how to swim?


Babies arrive already swimming thanks to their nine months living in the
fluid world of the womb, so introducing them back into water soon after
birth means they can re-experience the weightless, protective world they
were in before they were born. This can be done by getting into a deep
bath with your baby and, by using the flannel and a cup, gradually get her
used to the sensation of water on her head and face. Early bath time
experiences build a good foundation for starting a structured program
when they are six to twelve months old.

Under what conditions should swimming lessons take


place?
It is important to make sure the baby is happy and comfortable in the
water, which means the parent has to be happy and comfortable as well.
The water needs to be warm—at least 32°C, still, properly treated and
circulated. Unfortunately babies with eczema cannot swim in chlorinated
water as the drying effect makes their eczema worse.

It is crucial that group baby/parent classes are conducted by experienced,


well-trained teachers in a caring environment where individual differences
are respected and lessons are geared to the developmental ages of the
babies/toddlers.

Should baby/toddler swimming classes always be one-


on-one with a parent?
Definitely, up until at least three years of age. Classes should have a
maximum of six. It’s just as important for parents to spend time in the
water and learn how to handle their babies safely and confidently in the
water as it is for the babies to become familiar with and enjoy the water.
What are the main aims of teaching babies/toddlers to
‘swim’?
To learn to love and enjoy the water as a familiar environment whether
it be in the bath, under the shower or in a pool, and in the process (at
their own pace) develop balance, co-ordination and strength in and
under the water in a similar way that babies move from sitting to
crawling to walking on land.

Learning to swim and feel confident in the water is a core part of


human development especially in a country like Australia where the
climate and easy access to the ocean, rivers and pools means water is
very much part of our culture. Swimming helps keep us fit and healthy,
is a great social bond, and a source of relaxation and pleasure that lasts
all our lives.

During the baby and toddler years the one-on-one skin contact in the
water between the mother or father and baby is close and bonding. It
also helps promote good sleep and a healthy appetite—a potential boon
in the toddler years when both these areas can be problematic.

Water safety is a big issue in Australia. Safety is a often a motivating


factor for parents in teaching the under-threes to swim and while water
skills in this age group may contribute to averting a catastrophe, the
ability to float or ‘swim’ is not a guarantee against drowning. It is
crucial that parents are aware of all drowning prevention strategies—
see above.

How many times a week should babies/toddlers go


into the water?
Ideally, weekly is good. As learning to swim is a long-term process it is
something that needs to be done consistently to maintain the
baby/toddler’s comfortable feeling of being in and under the water. When
there is a long break, for example, because of illness or during the winter
months, parents may find they have to start familiarising their toddler with
water all over again.
What about parents who are feeling pressured to rush
their under-threes into formal swimming classes on a
regular basis?
Often this is not possible for a range of reasons which include illness and,
for many families, the cost factor.

Do what you can in the bath, in the wading pool and, as often as possible,
swimming one-on-one with your baby/toddler in a pool.

Make it fun, avoid pressure and force.

A little more about routines


I am returning to this because I know it is something that occupies lots of
mothers’ thoughts.

A reminder—if you are a routine person, don’t despair if things are still a
trifle chaotic. Once your baby is sleeping all night or most of the night
without waking you and eating three meals a day, your days will become
much more predictable. This happens between six and nine months for
many mothers and babies.

You might find your days are in some sort of pattern now without you
realising it. Feeding and sleeping times often vary from day to day. That’s
to be expected, but if you feel like it, write down your schedule over a
weekly period and you will probably find a predictable pattern is
emerging. ‘Strict’ routines are difficult to maintain. Trying to keep to one
means structuring your life exactly around the baby’s schedule, which
limits your movements and usually means putting up with an intolerable
amount of baby crying for no constructive purpose when she wakes early
for a feed or suddenly varies her sleep patterns. Illness, holidays, moving
house or visitors can also play havoc with strict routines.

Here’s a flexible guide if you are looking for one:

5 am to 8 am: Baby wakes. Breastfeed or bottle. Stays up for about an


hour. Bath may be here. Put to sleep—may sleep half an hour to two
hours.
9 am to 12 noon: Breastfeed or bottle plus food from a spoon if
appropriate. Bath may be here. Up for about an hour. Put to sleep or go
out. Baby may sleep half an hour to two hours.

1 pm to 4 pm: Breastfeed or bottle plus food from a spoon if appropriate.


Baby may only sleep for a short period. Awake the remainder of the time.
This may be a whingy, grizzly part of the day. Go for a walk.

5 pm to 7 pm: Bath may be here. Breastfeed or bottle and/or other food if


appropriate. Avoid letting your baby have a late ‘catnap’ if you can as this
interferes with bedtime.

7 pm to 8 pm: Bedtime. Try to keep bedtime regular and consistent


regardless what happens the rest of the day. Total sleeping in the day
varies from one to four hours. A number of babies only ever catnap. It is
usually very difficult to ‘make’ babies who catnap in the day sleep more or
longer. (See chapter 28 for more on daytime sleeping.)

If some sort of pattern is important to you, follow a similar plan each day
and don’t keep radically changing the times you feed, bath and put your
baby to sleep but stay flexible, because she might radically change what
she does from time to time. The main aim is to have a nice time with your
baby so don’t do anything that doesn’t suit your lifestyle or nature.

The crying baby


The majority of crying, unsettled babies are much happier by three to four
months. Unfortunately a number of otherwise healthy babies stay the
same, which is distressing for the baby and demoralising and exhausting
for the parents. Most of the time a definite cause is never found. Living
with the baby the way she is until she gets more used to the world is
usually the only option. Continued support from a sympathetic health
professional you can talk to and uncritical friendship from other parents
helps through the difficult times.

If your baby doesn’t sleep much during the day go out as much as possible
and try to be with people who care about you as much as you can so you
are not on your own.
A few babies stay distressed for the first year, but the overwhelming
majority are much happier and quite different little people by the time they
are six months old.

Sudden crying episodes or a sudden change in


behaviour
Babies, like all of us, don’t stay the same day in and day out. Sudden
erratic changes are quite common. ‘Bad’ days, sometimes weeks, continue
to happen. Most of the time it is difficult to know exactly why the baby is
behaving differently. Sometimes it might be because of one of the
following:

An impending infection: This may be a head cold and involve an ear


infection, a sore throat or a tummy bug which causes diarrhoea and
vomiting. Ear infections are not common under six months, but it’s
always worth having your baby’s ears checked if she suddenly starts
crying a lot and sleeping less. If the unhappiness is accompanied by a
high fever and no other symptoms the urine should be tested. A cross
baby may signal a dose of the measles, rubella or chicken pox—not
common in the first year, but can happen.

Reflux heartburn: This can be a cause of distress for babies after the
first three months when previously it wasn’t a problem. Reflux
heartburn is always difficult to diagnose and, as in the first three
months, probably diagnosed far more frequently than it actually occurs.
Sometimes medication for reflux heartburn helps babies who suddenly
become unsettled when other causes can’t be found.

Change in diet: Starting new food does upset some babies, even when
it’s only bland old rice cereal, so it might be worth stopping the food for
a week if the change in behaviour coincided with starting new food. Go
back to milk only and see what happens.

Hunger: Some babies suddenly become irritated or upset if they are


hungry. Check your baby’s weight. More food might be needed.

No obvious cause: When there’s no obvious cause to ‘fix’ you will


probably find your baby settles again in a short time without you doing
anything. Sometimes it’s boredom (try to go out more), over-tiredness
(try staying in more) or some disruption in the home (visitors, moving
house or building an extension).

Growing teeth
Many people, of course, will tell you your baby is ‘teething’ when she is
unsettled. ‘Teething’ is an explanation which supplies a reason at times
when it’s difficult to know if anything is wrong and replaces ‘colic’ once
babies are over three months old. As babies grow twenty teeth some time
in their first three years, there are always going to be times when the
emergence of a tooth coincides with developmental changes, normal
strange baby habits, nappy rash and illness.

I must admit I’m sometimes tempted to take a less direct approach to the
teething issue as I am aware my beliefs seem to upset, even anger, many
parents, which is not my intention. I completely understand that on an
individual basis it is reasonable to blame teeth for the myriad and often
mysterious behavioural, medical and developmental events that come
along in the first three years. For example, it is reasonable to see an
emerging tooth as a cause of, let’s say, diarrhoea and nappy rash if the
arrival of a tooth coincides with an attack of diarrhoea. And even more so
if your perception is that the arrival of a tooth coincides with every attack
of diarrhoea. And given that many health professionals have contradicting
views to mine, that traditionally teething as the cause of a multitude of
baby/toddler problems is an ingrained belief that goes back for centuries,
and that it is impossible to prove anything conclusive by research, then I
can understand why it is so hard to shift both health professionals and
parents on this.

My opinion is based on looking at and hearing about every facet of babies’


and toddlers’ lives for twenty-five years. During this time I always
endeavoured to avoid fobbing mothers off with simplistic answers. For
example, ‘just let him cry’; ‘give him food—that will make him sleep’;
‘it’s teething’; and so on. It became apparent to me after several years that
‘teething’ as a reason and/or a solution to baby and toddler problems was a
simplistic response which rarely—if ever in my experience—solved the
problem. Obviously just shrugging and saying ‘I don’t believe in teething’
is also a fobbing off, unhelpful, simplistic response, which is why I go to
some length to explain why I think the way I do and provide other reasons
for the behaviours, illnesses or strange activities during these years. It has
never been my intention to somehow imply parents are foolish people who
don’t know what they are talking about, which seems to be how my
message is interpreted at times. I acknowledge that there may be
occasions, after everything else is ruled out, that ‘teething’ might be
contributing to the concern, however I believe it is helpful to think broadly
about this and to keep an open mind. If you are interested in my ideas on
teething it’s more helpful to read all that follows rather than just taking bits
out of context so you get the whole picture.

Let’s look at the growing of teeth.

The first tooth appears some time between fourteen weeks and sixteen
months of age. It announces its presence by simply appearing—sometimes
a small lump comes first. No secret signs heralding the arrival of a tooth
exist, so a health professional cannot peer at a toothless gum and announce
that a tooth will or won’t appear next week! After the first tooth arrives,
others pop up at varying intervals. The central bottom teeth are usually the
first to appear and while most teeth do emerge in a set sequence it is not at
all unusual for some babies’ teeth to appear out of sequence. For example,
sometimes the top side teeth come before the top central teeth which gives
a gleeful ‘Dracula’ appearance until the top central teeth appear.
Occasionally the top central teeth arrive before the bottom central teeth.
The first twenty teeth arrive during the first two-and-a-half years. They are
lost and replaced by thirty-two permanent teeth between the ages of six
and twenty years.

Growing and losing teeth is normal for all humans and happens on and off
for twenty years or longer. Several hundred years ago the emergence of
teeth in babies was frequently given as a cause of death. At the turn of the
twentieth century ‘dentition’ (a word to indicate the growing of teeth)
appeared in dental textbooks as a cause of epilepsy. Science has made us
realise how illogical these notions are, but to a lesser degree we are still
being just as illogical. When seven- and eight-year-old children are
growing teeth (some teeth at this age growing for the first time) scant
attention is paid. ‘Teething’ is never a suggested cause for illness or
behaviour changes in this age group because older children can
communicate and have more predictable behaviour, so it is easier to
identify exactly what the problem is. Pain associated with teeth in
childhood and adulthood is caused by infections, decay and impacted
wisdom teeth.

I understand that on an individual basis there are many times when an


emerging tooth coincides with a bad day or night, a nappy rash or an
illness, but overall there are many more times when ‘teething’ is blamed
for a variety of conditions and the tooth never arrives.

After observing many babies for many years I am convinced that the
perception that growing teeth causes problems in babies is confused with
normal development and illnesses caused by other things. While this may
not be a popular approach I think it is more useful for parents to
understand the many more rational reasons relating to their baby’s
development, behaviour and health than simply fobbing it all off as
‘teething’. ‘Teething’ also gives rise to the overuse of medications and gels
for gums which are sometimes used for months on end waiting for the
appearance of the elusive tooth.

Growing teeth does not cause a fever, body rashes, diarrhoea, colds,
coughs, ear infections, smelly urine or nappy rash. Persisting with these
myths may mean treatment is delayed or a serious illness is not diagnosed.

Funny baby habits such as pulling at ears and constantly putting fists
in the mouth are developmental and part of a baby’s growing intense
curiosity with her own body. I observe or hear about babies doing these
things all the time. Most of the time it is not in conjunction with growing a
tooth; when it is, I suspect it is a coincidence.

Red cheeks appear a lot and are due to sun, wind, saliva and cheeks
constantly rubbing on clothes and sheets. Baby cheeks have sensitive skin,
stick out a lot and are easily affected by these things.

Dribbling is a constant feature of babyhood from three months to eighteen


months or longer. Saliva first appears around three months in copious
amounts and until babies learn to swallow their saliva the dribbling
continues regardless of the growing of teeth.

Sleep problems are not caused by teeth emerging and once your baby is
over six months if her sleep patterns are causing distress for the family
constantly blaming teeth does not solve the problem.

Does teething cause babies discomfort? Certainly not for three months
before they are visible! Nor do they cause pain by ‘moving around under
the gum’. An uncomfortable sensation just before the tooth emerges may
worry some babies and if you decide an emerging tooth is causing a
problem for your baby, a one-off dose of paracetamol is the safest
medication to use. If your baby is very distressed and behaving in an
unusual way, never assume the problem is simply teething. Look further
and if necessary seek a second opinion.

Other teeth tid-bits


A bluish swelling is often present on the gum when a tooth is emerging.
This is normal and not painful for the baby.

Growing teeth is not a developmental milestone and the stage at which


they appear has nothing to do with a baby’s future intelligence.

Babies do not need teeth for eating a variety of food, for example bread,
rusks, fruit, cheese and so on.

Care of teeth
Currently in Australia 40 per cent of children develop avoidable dental
caries before their sixth birthday. Up to 8 per cent of these children have
serious decay that requires treatment under general anaesthesia.

There are rare genetic conditions, medications and some illnesses that
decrease resistance to decay, but most children start out with the potential
to have strong and healthy teeth and gums for the rest of their lives.

Four interacting factors that affect this potential


1. An individual’s ability to resist decay: The predisposition of
individuals to tooth decay varies. We all know individuals with perfect
teeth who eat rubbish, never floss and rarely go near dentists. Similarly
some toddlers will not get decay despite lack of teeth cleaning, endless
bottles and sugary snacks. However, it is best not to rely solely on genetic
inheritance as it is unknown exactly who these individuals are or why their
teeth are unaffected. And—they are in the minority. On the bright side,
regardless of the genetic ability to resist decay it is highly unlikely that a
toddler will get caries if the next three factors are in place.

2. The dietary risk factor: The first line of defence against decay is
attention to diet, especially during the toddler years when effective teeth
cleaning can be difficult and when prolonged use of bottles is so prevalent.

Sugar is the main offender. Remember, sugar is sugar whether it is brown,


‘natural’ (whatever that means), honey or white. Other forms of sugar are
found in milk—cow’s milk (plain or flavoured) and formula—soy liquid
and fruit juice. Dummies dipped in sweet things or sucked by parents
before being placed into the baby or toddler’s mouth can also cause decay.

Bottles of anything other than water beyond the first year are a potential
cause of tooth decay, especially when they are used through the night or to
get the baby/toddler to go to sleep; the longer they continue the greater the
risk. There are no nutritional reasons to continue bottles after the first year
unless a baby has medical or developmental problems. Constant sipping of
juice and milk drinks from spout cups and straws throughout the day also
increases the risk of black teeth. Drinks of anything other than water are
best given in one sitting.

Breastfeeding and tooth decay


This is a vexed issue. Research suggests that there is no decay risk from
overnight breastfeeding beyond the first year because the milk is taken
right into the back of the throat and so doesn’t pool around the teeth. As
well, the components of breastmilk are thought to protect against decay to
some extent. Claims are also made that tooth decay is unknown in
traditional societies where babies are breastfed for at least three years. (Do
we know, though, what goes on at night?) Some breastfeeding researchers
believe that when tooth decay occurs in breastfed toddlers it is because of
other dietary factors and/or an inherent problem in a small number of
individual toddlers’ teeth. Statistically there is a much lower risk of decay
from breastfeeding overnight than drinking bottles of milk or juice
overnight, however, paediatric dentists who treat the problem are adamant
that constant breastfeeding overnight much beyond the first year is a decay
risk. Taking everything into consideration, I believe there is a small decay
risk that parents should be aware of if they are to be fully informed.

3. The teeth cleaning factor: Baby teeth are important and have many
functions. Here are some good reasons why it’s important to look after
them:

Baby teeth help the face and jaw develop properly.

Decayed teeth are unattractive, painful and cause smelly breath. As


children grow older they become aware of this.

Severe infections can cause dental abscesses and affect a child’s general
health.

Toddlers and preschoolers need healthy teeth for biting and chewing
efficiently. Bad teeth can limit food intake and if severe enough, slow
growth.

Healthy teeth are important for making the correct sounds in speech.

Baby teeth hold the correct space for the permanent teeth to erupt later
as replacements.

Cleaning baby and toddler teeth


Start cleaning your baby’s mouth even before the teeth arrive with a
washer in the bath.

Once a few teeth arrive, start using a brush—use a small toothbrush


with soft bristles. Toothpaste is not needed until around two years of
age.

It is recommended that children aged between two and six use special
low-fluoride toothpaste. Once they can spit, adult-strength fluoride
toothpaste can be used.

Apply a thin, pea-sized amount of toothpaste onto the brush.

Conduct the teeth cleaning in a brightly lit place.

Position yourself behind your toddler, standing or sitting, whichever


you prefer. This way she can’t get away when you put the toothbrush in
her mouth.

Your free hand can be used to support your toddler’s head or jaw or to
open the lips for better access. It’s a good idea to check for hidden
decay (a brown line which may be faint at first) by lifting the top lip
regularly, especially if she is still sucking bottles of milk or
breastfeeding throughout the night.

Encourage your toddler to look up at you and to ‘open up’.

Each tooth has five surfaces—a front, back, two sides and a top. The
aim is to clean each surface thoroughly. Avoid ‘scrubbing’. Use a firm,
brushing motion to remove the food.

Start with the back teeth as with a struggling toddler you may have
trouble doing a thorough job. The back teeth remain until age ten to
twelve so they need priority.

Brush twice a day once your toddler is happy to comply. Otherwise aim
for every day. Missing a day occasionally is acceptable.

Regular flossing is advised once the sides of the teeth touch.

Be prepared to be the main tooth-brusher for quite a few years. Children


do not have the manual dexterity to clean their own teeth properly until
they are around eight to ten years old. It is recommended that parents
make a point of brushing and flossing their children’s teeth once a day
until that age.

4. The fluoride factor: Fluoride protects against tooth decay bacteria,


strengthens tooth enamel and minimises the risk of decay. In many areas
of Australia fluoride is added to the water supply and the frequency of
tooth decay in children in those areas has decreased dramatically over the
last thirty years, although as noted there has been an increase again in the
last few years owing to other factors.

If you live in an unfluoridated area or use a water purifier (some water


purifiers eliminate all fluoride, others filter out a variable amount) it is
beneficial to give a fluoride supplement. For children under four this is
best done via the children’s low-dose fluoridated toothpaste mentioned
above. Once they are over four, check with your dentist about the use of a
fluoride tablets or drops. It is important to know the status of your water
supply before giving tablets or drops as too much fluoride can cause
permanent tooth discolouration.

Visiting the dentist


The first visit to the dentist is recommended at the end of the first year.
This may seem over the top to many people, but there is strong evidence
that a session with a dentist at this time is good preventative dental care.
The dentist will discuss all issues of diet, brushing, fluoride, feeding and
first aid for trauma. In Australia this is still a relatively new concept and
you may find some dentists are bewildered by a baby visit and are unsure
of what information should be covered. Look for a paediatric dentist or a
dentist with an interest in paediatric dentistry.

Blood in vomit
Occasionally a breastfed baby damages the nipple after teeth arrive. The
nipple bleeds so she swallows a little blood which may then appear when
she regurgitates. This is usually only a temporary problem—I have
included it because it can cause a moment of panic to suddenly see blood
in a baby’s vomit.
Thumb-sucking
Thumb-sucking is a normal activity for babies—many do it while in the
womb. Thumb-sucking has a few advantages over dummies. Skin is nicer
to suck than silicone or rubber, the baby can make her own decisions about
when to use her thumb and thumb-sucking doesn’t cause sleep problems
because babies don’t lose their thumbs in the night. Some parents worry
about thumb-sucking because they don’t like the look of older children
sucking their thumbs, they see thumb-sucking as a sign of stress, thumb-
sucking in older babies sometimes causes skin irritation on the thumb and
of course there’s the worry about the orthodontic bill.

Thumb-sucking does not indicate stress and has no effect on a baby’s


progress if the thumb-sucking continues throughout early childhood. Nor
does it affect teeth until the permanent teeth are through, at which time the
10 per cent of children who continue thumb-sucking push their teeth up
and out and orthodontics may be needed. I can’t help noticing how many
children have orthodontic treatment anyway whether they were thumb-
suckers or not, so it’s not an issue I see as highly significant. If your baby
is a thumb-sucker there’s not a lot you can do about it. Trying to get
thumb-sucking babies to take dummies instead is generally stressful and
unsuccessful.

Giving a dummy from birth to avoid thumb-sucking because ‘you can


throw the dummy away’ may introduce your baby to a habit you find as
unattractive as thumb-sucking, which is just as hard to break, may interfere
with breastfeeding and causes sleep problems to boot. Lots of babies use
neither.

If your baby develops a skin irritation on her thumb, try using a tiny dab of
diluted Povidone-iodine Sore Throat Gargle on the affected area three
times a day.

Some babies are so enamoured of their thumbs they suck them while they
eat. This is a harmless habit which may continue into the second year.

More about poo


Poo is a fascinating topic for those involved with babies and promotes
endless discussion at each age and stage.

A reminder about breastfed babies: Breastfed babies of this age who are
having no other food or milk may go up to three weeks without doing a
poo. When they go it will be a very large, soft one—everywhere! They
may also do very smelly farts in between poos. You do not have to do
anything to make your baby poo, but if you feel better seeing a poo a little
more often, try a little diluted prune juice or cooled, boiled water to hasten
up the process.

Constipation: Bottle-fed babies and breastfed babies who are eating other
food will do firmer poo, which may be a variety of colours. Breastfed
babies often get a little constipated when they first start food from a spoon.
It is normal for babies to grunt and groan and go red in the face when they
do a poo. If your baby’s poo gets hard and she gets very distressed beyond
the normal grunting, here are a few suggestions:

Stop banana for a while.

Stop rice cereal for a while—cooked pureed pears or ripe mashed


pawpaw help.

Increase fluids (extra breastfeeds, water, and in this case fruit juice is
helpful).

Try diluted prune juice. If your baby doesn’t drink from a bottle put the
prune juice in with her cereal or try prune juice and yoghurt.

A little added sugar in her cooked fruit or on her cereal helps.

When your baby is trying to do a poo and it seems difficult, lie her on
her back and bend her knees towards her stomach gently for two
minutes. Repeat a few times if necessary.

You should not have to resort to medication and suppositories unless the
constipation is extreme; the use of these things should be limited to a one-
off. Constant constipation that can’t be helped by diet needs a trip to a
paediatrician.

Recycled food in the poo: Once babies are eating a wide variety of food
quite a lot of food appears in the poo in its original state, so don’t be
amazed to see carrots, crusts or spinach. This is quite normal—no need to
change the diet.

Ammonia-smelling urine
Mothers are often amazed at how smelly their babies’ urine becomes as
their babies grow; this is especially noticeable the first nappy change after
a long sleep. As long as your baby is otherwise well and the urine is pale
and straw-coloured (although a little darker and concentrated first thing in
the morning), there is nothing to worry about. Naturally, if you are at all
worried, see your family doctor.

Skin things
Baby rashes in the first three months tend to be a normal response to
adjusting to wearing clothes and life outside the womb and generally need
no treatment. After three months, rashes and skin things are either caused
by medical conditions or because of contact dermatitis caused by the
baby’s natural secretions coming in contact with her fine baby skin—for
example, saliva, urine, sweat or tears—and may need treatment. Let’s look
at the most common ones.

Eczema
Babies with eczema have dry, easily irritated skin.

What causes eczema?


The exact cause of eczema is still unknown. It is often believed that
eczema is due to an allergy and if the allergy can be identified and
removed the eczema will be cured. In fact, eczema caused by allergy is
rare. Babies who have eczema may also have allergies which give them
different symptoms. It is usually not possible to cure eczema by removing
a specific substance.
There is a strong hereditary component—when there is a family history of
allergic conditions such as asthma and hay fever a toddler has a much
higher chance of getting eczema, but one toddler in five who has eczema
has no family history of allergies.

Most babies and toddlers outgrow their eczema by age five.

What does eczema look like?


Eczema appears as a dry rash, which may become red, moist and itchy.
Some areas of the skin can become inflamed and weepy. Depending on the
severity it can appear anywhere on the body. Particularly affected areas are
the faces of babies and the fronts of the knees and ankles and inside of the
wrists of toddlers. It tends not to appear in babyhood until after the first
three months. In some babies and toddlers the whole of the body is
affected.

Degree of discomfort
Eczema can be mild, moderate or severe. The more severe, the more
widespread and itchy it becomes.

Mild eczema often presents as a round, dry patch which is often confused
with a ringworm infection. A ringworm infection, however, has to come
from somewhere and if your baby has not been in contact with a person or
an animal with ringworm the round dry patches are more likely to be mild
eczema.

Treatment
The main line of treatment is the use of moisturisers to keep the skin
supple and to avoid common skin irritants (see over page). Sorbolene with
10 per cent glycerine is inexpensive and effective, but sometimes stings if
the skin is raw. It is available in pharmacies and supermarkets in big tubs.
Apply as often as you can, at least twice a day, especially after the bath
and at night before bed.

Alternatives such as Eucerin ointment, bath oils or Alpha Keri are suitable
if the sorbolene and glycerine irritates or stings the skin. It is important not
to use disinfectant preparations on eczema as this will irritate the skin
further.

Occasionally a mild cortisone ointment will be needed. This is best used


twice a day on the affected areas.

Advice from a dermatologist is advisable for more severe eczema as the


treatment is more complicated. Sometimes the skin becomes infected and
needs oral antibiotic treatment and/or a period of time in hospital with wet
dressings to bring it under control.

Common skin irritants for babies with eczema

Sand.

Soap, detergent and bubble baths. Sorbolene and glycerine or aqueous


cream is a good soap substitute.

Perfumed and medicated products, wool and acrylic materials found in


clothes, carpets, furniture and car seat covers.

Chlorinated swimming pools.

Dry air (air-conditioning and heating).

Increased sweating due to heat or exercise.

Occasionally, food.

The relationship between food and eczema


Research into the relationship between food and eczema is conflicting and
the success of dietary measures varies tremendously with individual
toddlers. When they work, the eczema is improved but not cured. Before
radically altering your toddler’s diet, it is a good idea to talk to a paediatric
dietitian to make sure the diet is adequate for proper growth.

Complications
Babies with eczema should be kept away from people with cold sores as
they are particularly susceptible to the cold sore virus. These babies are
also more prone to the contact dermatitis lots of toddlers get from time to
time which causes nappy rashes; red, chapped cheeks; rashes around the
mouth and eyes; cracking behind the ears; and red, moist areas under the
chin.

See chapter 18—Minimising the risks of life-threatening allergic reactions


—for information in relation to food allergies, for example peanuts, and
eczema.

Red cheeks
Red cheeks are very common in babies and toddlers until dribbling stops
and their cheeks stop constantly coming into contact with clothes and food.
Baby cheeks are very soft and chubby and stick out so they catch the wind
and sun easily, becoming dry and chapped especially in winter. Red
cheeks (or sometimes only one red cheek) are not related to ear infections,
‘teething’ or diet, although once the cheeks are red and dry, acidic food
such as oranges may irritate them further.

Red cheeks are often hard to clear up as the irritants can’t be removed but
they don’t seem to bother babies at all. Try to keep the skin around the
area dry, apply sorbolene and glycerine whenever you can (a tricky job—
babies don’t like it much) and last thing before bed apply a soothing
barrier cream. A mild cortisone ointment helps if the redness is very
severe. Ointment always works better than cream on moist areas.

Rash around the mouth


Again, very common and caused by saliva, milk and food being constantly
on the baby’s face. Using a dummy contributes as the fluid gets trapped
under the plastic shield which surrounds the teat. Certain food may make
the rash worse (orange juice, tomatoes, eggs or yoghurt). This is a
frustrating rash as it’s often difficult to clear completely until the baby
stops dribbling.

Try to keep the area as dry as possible. Apply a soothing barrier cream at
night. Experiment a little with food—don’t get too uptight about food or
you may find your baby’s diet is very restricted and the rash is still there
anyway.

If this rash gets really bad, check with your family doctor or a skin
specialist to make sure there is no underlying bacterial infection (from a
snotty nose) which needs antibiotic treatment. If not, the only way to clear
it is to apply a mild cortisone ointment (not cream) regularly. This takes
some time to clear it but it does eventually.

Red under chin


Another maintenance problem until your baby holds her chin out from her
neck and stops dribbling (around twelve months). Here’s how to look after
it:

Always dry well under your baby’s chin. To do this, lie your baby down
and firmly but gently pull her chin away from her neck. After you have
dried the area apply some zinc and starch powder with your fingers under
the chin from ear to ear. The zinc and starch powder absorbs moisture and
separates the skin surfaces. The more often you can apply it the better the
results, so see if you can do it most nappy change times when you are at
home. Your baby might not like it much at first, but she will get used to it
quickly.

If the area becomes very inflamed, shiny and weepy, see your family
doctor. A combination of a mild cortisone and anti-fungal ointment will
clear it. Afterwards, it is better to continue to use the zinc and starch
powder. Diet makes no difference to this rash.

Cracking behind ears


This may be related to eczema or simply to moisture behind the ears
causing irritation to the skin. It tends to be an on-again, off-again little
problem which can go on throughout the first year. It’s another
maintenance problem—here are a few tips:

Always dry well, but gently, behind your baby’s ears every day and
check to see what’s happening.

Frequent applications of sorbolene and glycerine help keep the area


supple, so apply a little every nappy change time while you are at home.
If the area behind the ears becomes very inflamed, cracked and weepy,
see your family doctor. A combination of a mild cortisone and anti-
fungal ointment will clear it. Continue with the sorbolene and glycerine
when it is clear. Diet makes no difference to cracking behind ears.

Heat rash
Heat rash continues to return from time to time, often until the age of
three. Heat rash in older babies looks like little reddish-blue separate dots
and appears mainly at the back of the neck, on the tummy and the top of
the chest, and often arrives with hot weather. It mostly doesn’t bother
babies, but is sometimes itchy, especially around the back of the neck.
Heat rash is not related to diet.

Mosquito bites
Mosquito bites look like a flat red tiny spot almost like a dot from a red
felt tip pen. Mosquito bites usually disappear without incident.

Pigeon lice bites


Pigeon lice bites are often confused with chicken pox as they appear as
small, raised pink spots which form a blister and a crust. If your baby gets
a few lesions like this when she is otherwise well and has not been in
contact with chicken pox, pigeons may be the culprit especially if you live
somewhere, where there are a lot of pigeons.

Impetigo
Impetigo happens when a lesion on the skin becomes infected, usually
because the baby scratches it. The lesion slowly enlarges and spreads. It
may be crusty, pus may be present and other lesions may start to appear.
See your family doctor—impetigo needs antibiotics.

Baby acne
Occasionally a baby develops inflamed pimples and blackheads on her
face which looks very similar to a mild form of teenage acne. It is not
related to the hormone rash most babies get in the first three months which
is often misnamed ‘baby acne’. It is an uncommon condition called
infantile acne and tends to happen to babies who come from families
where there is a strong history of acne in the teenage years, although this is
not always the case. There is no wildly successful treatment, it doesn’t
bother the baby and goes some time in the first two years, maybe to return
in the adolescent years. Baby acne is not affected by diet.

A yellow baby
If your baby is otherwise well but turning yellow before your eyes, it’s
almost certainly because of her consumption of foods containing
betacarotene, such as pumpkin, carrots, spinach, tomatoes, peaches,
apricots and prunes. Quite a few babies eat a lot of pumpkin and carrot.
Betacarotene is a yellow pigment which is converted by the body into
vitamin A. The yellow skin is harmless; the betacarotene does not have
this effect on the skin after age three. There is no need to reduce the
offending food items as they are all very good for your baby, however,
regular large amounts of carrot juice poses a slight risk of a build-up of
vitamin A. This can pose a health risk so avoid overdosing your baby on
carrot juice.

Small lump under nipple


It is quite common to be able to feel a lump under the nipple in one of your
baby’s breasts. This has nothing to do with the swollen breasts that babies
under three months develop due to hormones (Red, swollen breasts, see
chapter 10). Small lumps in older babies is normal breast tissue and
nothing to worry about, but check with your doctor if you are unsure.

FOR MORE INFORMATION


Chapter 5: Choosing Baby Products (dummies)

Chapter 6: Breastfeeding Your Baby For the First Two Weeks (notes on using weight as a guide
to hunger)

Chapter 14: Sleeping and Waking in the First Six Months (‘sleeping through’;
‘spoiling and routines’)
Chapter 15: The Crying Baby

Chapter 24: Feeding Your Baby (tips on using a cup)

Chapter 25: Common Worries and Queries (funny habits)

Chapter 28: Sleeping and Waking Six Months and Beyond (sleep problems and ‘teething’)

Chapter 29: Feeding Your Baby (biting the breast)


20

Growth and Development


Previous chapter | Contents | Next chapter
Growth: 6 months
Babies roughly gain 140 to 170 grams (5 to 6oz) a week in the second six
months and grow about 2.5cm (3/4 inch) in three months. Before you start
to worry, here are a few statistics so you can see the wide normal range.
Small/Normal Large/Normal

Weight 6.2kg (13lb 2oz) 10kg (22lb)

Boys Length 63cm (26 inches) 73cm (29 inches)

Head circ. 41.5cm (16 inches) 46cm (18 inches)

Weight 5.8kg (13lb) 9.2kg (20lb)

Girls Length 61cm (24 inches) 70cm (27 inches)

Head circ. 40cm (15 inches) 45cm (17 inches)

Development
Gross motor skills
Between three and six months your baby starts a lot of new movements,
some at four months, some at five months. By six months you will notice
that:

When she lies on her back she raises her head to look at her feet.

She lifts her legs to play with her feet.

When she is on her tummy she takes her weight well on her forearms.

She has great head control. When you pull her from lying to sitting, she
braces her shoulders and pulls herself towards you to sit.

She might be able to sit on her own. Some babies can sit on their own
by six months, for most sitting unsupported happens between six and
nine months. It’s fine to let babies sit, well supported so they don’t fall
and hurt themselves, before they can manage to sit on their own—doing
this doesn’t damage their backs.

She is probably rolling. By six months a lot of babies roll from front to
back and/or from back to front, but the age at which babies intentionally
roll is extremely variable. Some do it once or twice and don’t do it
again for a long time, others still haven’t rolled by nine months. Safety
is an important consideration in relation to rolling. Never assume your
baby can’t roll because the very time you leave her unattended on a bed
or change table could be the first time she does it—onto the floor!

She likes to be held standing so she can take her weight and bounce up
and down. Most babies do this by six months, however, some still have
collapsible legs. If your baby doesn’t weight bear, give her some
practice when you can, as well as plenty of floor play and no walker.

Vision and fine motor


Babies of this age are delightful stickybeaks, vitally interested in
everything and everyone around them. Eyes should now move together.
If they look uneven or crooked, have them checked.

By now your baby will be reaching out and grabbing everything in


sight. She passes toys from one hand to another, usually via her mouth,
for a chew and a suck. Exploring things with her mouth and tongue is
her way of getting additional information about all the things she sees
and touches. At times she will get quite frantic about this process of
discovery. It is important that your baby is able to suck, bite and mouth
safe objects without too many inhibitions placed upon her.

When an object is dropped to the floor your baby will look for it
purposefully rather than continuing to stare at the spot from where it
disappeared.

Hearing and speech


Hearing
By six months babies turn consistently to a voice or a noise as long as they
are not too distracted. This might be a voice from across the room or a
quiet noise from something like a rattle behind each ear.

Speech
Speech is in the form of tuneful, sing-song vowel sounds. Some babies of
this age start single or double syllables (ga-ga, da-da, ma-ma) although
most don’t start these sounds until a little later. A number of babies go
through a ‘quiet’ stage between five and seven months where they don’t
make as many talking noises as they did when they were younger. Don’t
worry—it all starts up again! Laughing, chuckling, squealing and
screaming are all part of their speech now.

Social and play


Your baby will now start to bang things together. When you offer her a
rattle she will reach for it immediately and shake it deliberately. She will
laugh at things and people and especially enjoy games with a surprise
element.

Toys
This is the age for movement, kicking, reaching and grasping and chewing.
An onion bag full of cellophane makes interesting noises and attracts
attention.

Washable safe rattles and shakers are popular. An unbreakable mirror


mounted about 18cm (7 inches) away from your baby’s face on a wall
where she can look at herself is good entertainment value.

Mobiles still attract attention. By six months your baby will be reaching
and grabbing so make sure it’s well out of reach.

Activity centres manufactured by various companies are a great favourite,


especially between six and nine months. Balls are always fun.

Specially designed playmats for babies to lie on give them things to grab
and chew and make noises with while they are on the floor.

Books

The first five years are vital for literacy development


Babies come into the world wired to learn language from the time they are
born, so parents have a captive audience. Babies and toddlers are eager—
almost desperate—to absorb the language they hear around them in their
homes and their communities.

Before children start school most of their literacy learning comes from
within their families. It comes from the way their parents and extended
family talk and communicate with them. It comes from family stories,
songs and music and from books, magazines, and comics—in fact, from
anything in their world that draws their attention to words and pictures.

Literacy learning for most children has the potential to come naturally as
part of the close relationship they share with the adults in their lives. You
don’t have to be an ‘expert’ to talk meaningfully to your baby or to read to
her.
Reading provides a never-ending supply of scenarios, people and
possibilities that children can use to create their own pictures and images
in their heads. It is a particularly self-sufficient form of entertainment,
which is a great bonus for parents.

Initially you may feel you aren’t getting far when your baby lunges at the
book and tries to eat it, but persevering is well worth the long-term
rewards. The earlier you start, the sooner your baby or toddler’s attention
span increases, and the sooner her interest is sustained.

Reading—when to start
The time to start books is as soon as possible after birth! Babies love bright
colours, the rhythm of the words and being held close.

If it is regular, even just for a few minutes a day, by the time your baby is a
toddler you will find she will be responding in a most rewarding way.

When babies are at the grab-and-eat stage, give them something to hold
and chew to keep them away from the book—a set of keys is good.

How to do it
If you were never read to as a child you may be wondering ‘how to do it’.
Don’t be embarrassed about this—it’s more common than you think.

The basic idea is to read expressively and enjoy the story; the more you do
it the less inhibited you’ll feel. Generally, babies become a rewarding
audience the more they are read to.

A few tips
Use books with big, bold pictures about things your baby is familiar
with. Babies, especially around five months and upwards, love books
with flaps to look under. Books with jingles, rhymes and sounds (sheep
baa-ing, ducks quacking and cars vrooming) are popular with babies as
well. Family photograph albums are also good.

Sit close and hold your baby on your lap. Point to the pictures and, as
well as read the words, embellish a bit—tell stories about what is
happening or what the people are doing. Keep going for as long as she
is happy, even if at times she doesn’t seem to be paying much attention.
At this stage you may be sowing the seeds for future interest and
enjoyment rather than capturing her immediate interest.

It is important that the book matches the baby. Libraries are invaluable.
If you are in doubt, go to your local library and talk to the people there.
If you’ve never been to your local library, go anyway. Apart from help
with choosing books, libraries are wonderful resources and lovely
places to take babies to visit. Good bookshops can also advise on
suitable books. Bear in mind that the books you choose should be as
enjoyable for you as your baby; reading aloud is much more fun when
the adult loves the story and the characters as much as the baby does.

It’s a good idea to have books around the house, easily accessible so
your baby can learn how to explore books for herself. Your baby will
gradually start to look at the pictures and eventually bring the books to
you to look at with her. Books are also a welcome diversion when you
are out and about doing routine things that babies find boring.

Developmental summary: 6 months


Gross motor
on back—lifts head to look at feet;

lifts leg and grabs foot;

pulled to sit—braces shoulders, no back curve;

can roll, front to back (very variable).

Vision and fine movements


moves head and eyes eagerly;
a squint is abnormal;

uses whole hand to grasp objects and passes them from one hand to
another;

watches falling toys.

Hearing and speech


turns immediately to parents’ voices;

turns to minimal sound;

makes tuneful talking noises and may use single or double syllables;

laughs, chuckles, squeals and screams.

Social and play


puts everything into mouth;

reaches out and grabs things;

may be wary of strange faces and places.

Growing and developing—when to


worry
It is natural for you to watch your baby closely and to be concerned if she
doesn’t seem to be growing or is late to reach a milestone. Constant
comparisons with other babies and listening to other parents’ experiences
may increase the worry that ‘something is wrong’. Here are some
guidelines for action if you are not sure that your baby is growing and
developing normally.
Growth
Sometimes parents are concerned or are made to feel concerned because
their baby’s weight is less than would be expected for her age and height.
Family and friends make comments or it might be noted by a health
professional.

If you are concerned about your baby’s weight, have her weight, length
and head circumference taken by someone reliable then plotted on a
percentile chart. None of these measurements mean as much taken on their
own as they do taken together and plotted on a growth chart so that her
overall pattern of growth can be looked at. Her weight should be around
the same percentile as her height, but there are always a number of babies
who weigh one or two percentiles below their height or one or two above.
When they are bright, active and feeding well, there is unlikely to be a
problem.

Appearances can be quite deceptive and comments made by onlookers


(‘what a small baby!’) are generally quite wrong, so if you’re worried, nine
times out of ten this simple procedure is all that’s needed to put your mind
at rest.

If low weight is a pattern and your baby’s weight percentile is a long way
below her height percentile, here are the most common reasons which do
vary with ages and stages of development:

Diet
Persistent low gains in healthy babies in the first three months are often
related to breastfeeding problems. Once these are overcome the weight
should increase. Care must be taken before abandoning breastfeeding as
some babies continue to gain only small amounts on formula.

Incorrect mixing of formula is occasionally a cause of low weight gains in


the early months.

Older babies who are given very restricted diets may not gain weight for
long periods. An abundant supply of breastmilk still supplies most dietary
needs beyond six months of age, but when the supply is noticeably
diminished it is very important to include other fats in the diet such as
milk, cheese and yoghurt. Babies do not thrive well on small amounts of
breastmilk and fruit and vegetables only. If for some reason dairy products
are eliminated, a fortified soy formula is the best choice of extra milk as it
has added fat. As there are problems with soy—apart from its unpleasant
smell that seems to linger around babies—think through carefully as to
why you are using soy. Other cows milk formulas—low lactose or HA—
may solve whatever problem your baby is having with ‘dairy’. For a
refresher on infant formula see chapter 7.

It is quite common for babies to start refusing food some time between
nine and twelve months, which is a constant source of worry for lots of
parents. It is also a time when the weight of many babies, especially
breastfed babies, levels out. As this is normal for most babies, try not to
worry. Babies cannot be forced to eat so the best thing you can do is to
make sure you offer your baby an adequate diet which includes a range of
foods. Health problems in healthy ‘non-eating’ older babies only happen
when they are consistently offered the wrong food or put on crazy fad
diets.

Illness
Continuing stationary or low weight gains may be caused by illness.
During the first year medical problems such as a urinary tract infection,
pyloric stenosis (a narrowing of the passage between the stomach and the
small intestine), a heart problem or other rare illnesses may be diagnosed
and treated. Acute illnesses such as viral diarrhoea, upper respiratory tract
infections, ear infections or tonsillitis can all affect weight gains. Medical
problems are nearly always accompanied by signs other than low weight
such as strange-smelling poo, apathy, fevers, delayed development,
irritability or constant unhappiness.

Most underweight babies and toddlers have nothing at all wrong with them
and no one knows precisely why they are underweight. The difficulty
always is deciding when the reasons for being underweight need
investigating. The approach of health professionals to underweight babies
and toddlers varies tremendously so parents find they often receive
conflicting advice. Techniques used to diagnose possible medical causes
are invasive, often expensive and should not be done as a matter of course
on all underweight babies.
When your baby is bright and active, lives in a loving home, is offered an
adequate diet, does normal poo and continues gaining some weight every
so often, there’s unlikely to be anything wrong. Chasing diagnosis after
diagnosis is a nerve-racking exercise which rarely changes anything.

If your baby has a sudden weight loss and shows obvious signs of illness
or if you are concerned about her milestones, see your child and family
health nurse or doctor. Babies born ‘small for dates’ will catch up, but
some won’t until their second year. Premature babies of very low birth
weight tend to stay small for the first year or two but follow a steady
growth pattern of their own.

Height problems, either too short or too long, are not common but do
occur. Height anomalies tend to emerge over a period of time and are more
likely to be noticed in the second year. When it appears height is outside
the normal range, special attention is needed from specialists in the field.
As with weight, the first thing to do is to work out whether a height
problem exists. Your child and family health nurse or family doctor can
help with this.

Development
Remember, milestones are a guide. Listening to other proud parents
boasting about their baby’s achievements can be hazardous to your peace
of mind. Variations in skills and personality differences between babies
are just as diverse as they are between adults.

Unless there is a generalised delay in a few areas over several months it


doesn’t matter if your baby seems slow to do some things compared to
other babies. Gross motor skills such as walking, sitting, crawling and
rolling have the widest variations and are highly visible. Parents are very
aware when their baby sits like a blob at twelve months while their
friend’s baby of the same age is ready to start Little Athletics.
Delay in gross and fine motor skills can be helped by physiotherapists and
occupational therapists if you and your adviser think it’s appropriate.
Communication skills are very important, so if you ever think your baby
can’t hear or see, seek help immediately. Here is a general guide about
when to go for assessment. Start out with your child and family health
nurse, your family doctor or paediatrician, who can tell you where to go
next if it’s necessary.

Seek help if
your baby consistently doesn’t respond to sounds;

your baby doesn’t seem to see things or has white or cloudy eyes;

she isn’t interested in what’s going on around her;

she can’t hold her head up by three to four months;

she squints a lot after three months; eyes not focusing;

persistent and excessive crying continues after three to four months;

there’s no babbling by six months;

she doesn’t use or move both arms and/or legs;

your baby is not sitting well by ten months;

she doesn’t want to weight bear by twelve months.

This is only a very general guide. Always get professional help if you are
unsure. You know your baby better than anyone and have a good feel for
what’s happening. Too many opinions will drive you mad, but a couple of
assessments by different people can give you a better idea of whether a
problem exists or not, the degree of the problem and the best course of
action.

FOR MORE INFORMATION


Chapter 13: Growth and Development (understanding percentile charts)

Chapter 17: Equipment (baby walkers)

Chapter 24: Feeding Your Baby (fat in diet)

Chapter 32: Becoming a Toddler (not eating)


21

Safety
Previous chapter | Contents | Next chapter
The following chart emphasises particular hazards associated with this
developmental stage, but remember, most safety hazards remain at any age
and stage.

Don’t forget your baby’s second round of immunisation is due at four


months.
Developmental
Age Safety hazard Precautions
stage

Eyes off, hands on is the golden rule


Falls off heights
Check all toys for small removable parts
Rolls over Inhalation of small, loose pieces of or household objects/utensils that can be
3–4 toys or other small objects sucked
months Starts to mouth
objects Scalds by baby grasping and Keep all hot liquids out of baby’s reach
spilling hot drinks while being
nursed Think about the way you drink tea and
coffee, especially when friends visit

Suffocation by inhalation of food


Always supervise with food or bottle
4–5 May feed self Choking, inhalation hazards as baby
months biscuit or rusk Constant supervision and monitoring of
has increasing access to small, hard
bits and pieces left around the home
objects

Falls—from highchair, pram, Safety harness and constant supervision


Increased
5–6 mobility by stroller, change table in highchairs, prams and so on
months crawling and Burns—exposed fires, heaters, Use fireguards, limit exposure to the sun
rolling grasping hot objects, sunburn and cover up

Picks up ‘tiny’ Never leave alone in the bath or in the


bits Drowning—left alone in the bath
6–7 company of older children
months May sit alone Falls—from sitting or standing
Close supervision, especially if a baby
position
May pull to stand walker is being used

FOR MORE INFORMATION


Chapter 12: Safety (immunisation)
22

For Parents
Previous chapter | Contents | Part III
Contraception
Here’s a reminder: change from the mini pill to an IUD or the combined
pill if you wean or dramatically decrease your breastfeeding.

Night waking between four and six


months
It is normal and common for babies to wake at night after three months.
Some babies have never slept more than two to three hours at a time,
others may have slept most of the night from eight weeks only to start
waking frequently again around four to five months.

The amount of distress this causes parents usually depends on the number
of times it happens, how quickly the baby goes back to sleep after a feed
and whether both parents are in paid employment. Parents’ expectations
can cause added tension, especially when all their friends’ babies are
sleeping through. It is also hard to bear if the baby slept well at night for
several months and then started waking again.

What can you do?


Unfortunately, contrary to popular opinion, there is no safe, easy way to
‘make’ (an unfortunate word used a lot in this context) your baby sleep all
night.

Here is some information:

Illness sometimes causes a return to night waking. Wait for a few days
and see if something eventuates or ask your family doctor to check her
out, including her ears.

‘Teething’, ‘hunger’ and ‘wind’ are explanations you will doubtless be


given by most friends, relatives, colleagues and health professionals.
Is it teeth? Unfortunately, it’s rarely that simple, but if a tooth appears
and then she goes back to sleeping—hallelujah! I do not find the
growing of teeth relates much to wakeful night-time babies.

Is it hunger? Starting solids is usually the next suggestion.


Occasionally this does the trick and if so—great! If your baby rejects
the food completely then forget about it; chances are it would not solve
the night sleep problem anyway. Most of the time food seems to play a
very insignificant role in keeping babies sleeping at night.

Is it wind? When mothers are up a lot at night with babies, in their fog
of weariness they often become very aware of their babies’ farting and
burping habits and tend to see this as the problem. However, babies
who sleep all night burp and fart too—it’s just that because everyone
else is also asleep it passes by (or out) unnoticed. Troublesome wind is
unlikely to be a reason for night-time waking unless your baby has a
defined medical problem which would give her gut pain or she is
having a reaction to some new food.

Is your baby too big now for wrapping and being in a bassinet?
Sometimes moving the baby into a cot and stopping the wrapping helps.
Sometimes it makes things worse; however, give it a try. Put her in the
cot on her back with a sheet and blanket over her tucked in tightly
around the cot mattress.

If your baby has been managing without night feeds then suddenly
starts waking again, generally re-introducing a night feed is the best
thing to do. You can try replacing the night feeds with a dummy or by
rocking and patting, however, most of the time you will find you are up
more and get less sleep than if you feed. If you are only getting up once
or twice at night and your baby is going straight back to sleep I think
it’s better to carry on feeding and review the situation when she is over
six months old.

A lot of babies sleep from around seven at night until one or two in the
morning, wake for a feed, then wake hourly until the daylight hours. If
your baby is doing this, apart from the strategies already suggested, the
only other possibilities are: let her cry by following the teaching-to-
sleep guidelines in chapter 28 or live with it and hope it gets better.
Unfortunately I can no longer recommend taking your baby to bed, see
chapter 5.
Waking the baby at 10 to 11 pm and giving her a feed is often
suggested as a way of ‘making’ her sleep through the night. By all
means try it, but I find this strategy does not have a high success rate
and often makes things worse.

The dummy. If you find you are getting up frequently to put the dummy
in, it’s worth thinking seriously about getting rid of it. When the
dummy goes there is the dilemma of what to do when the baby wakes.
Unless you can quieten her quickly with a feed or a pat the only other
alternative is to let her cry.

Leaving babies to cry at night to teach them to sleep is dealt with in


detail in the next section as six months is the earliest most babies and
parents can handle this approach. However, if you are desperate and if
your baby is well, please refer to chapter 28 for the best way to do
teaching-to-sleep. If you have decided to take this approach it is better
to follow these guidelines than just to lie in bed listening to your baby
cry.

To summarise
Generally babies wake at night as part of normal sleep patterns and do not
know how to go back to sleep. Night waking is unlikely to be related to
easily explainable things like teeth, hunger and wind. Nor is it usually
anything to do with what the parents have or haven’t done.

If the night waking is not bothering you unduly, do nothing.


Once hunger and illness have been ruled out the options are to feed and
live with it or let the baby cry. Replacing feeds with dummies, rocking,
wrapping, patting and so on usually doesn’t work. Letting babies cry at
any time is fraught and a controversial approach, however, there are times
when parents feel there are no alternatives and wish to try.

If you want to do so before your baby is six months old, please follow the
guidelines for teaching-to-sleep closely. If there has not been a change for
the better in your baby’s night sleep patterns within three nights, stop and
wait until she is older. Stop before if you find it too distressing.
If you are feeling exhausted and out of control because of your baby’s
night waking, ask your child and family health nurse about the possibility
of going to a residential family and baby centre for four or five nights if
one is available.

Travelling with your baby


Travelling with a baby is different from travelling on your own. It is
rewarding, exciting and better than staying at home, but it is hard work.
Parents’ tolerance, expectations and anxiety levels when travelling with
babies and toddlers differ greatly from one family to another. Lots of
families travel vast distances regularly and thrive on it, other parents find
long trips with babies too much to bear and decide to only take
unavoidable trips until their babies are older. Don’t feel like a wimp if
you’re in the latter category or feel pressured into taking unnecessary trips
when you’d sooner stay home.

The first trip with your baby may seem quite daunting, but the more trips
you make the better you become at handling the tricky bits and enjoying
yourself at the same time.

To ensure as smooth a trip as possible, planning is essential. Planning


includes mental preparation so you don’t have too many unrealistic ideas
of what’s ahead. You will find you are not able to enjoy the same sort of
things you did when you travelled before your baby arrived. Leisurely
meals, shopping expeditions, fishing trips, extensive sightseeing, late
nights and long drives without stopping to get quickly from one place to
another tend not to be compatible with babies.

Be mentally prepared for the unexpected so you don’t feel too let-down
when things go wrong. Illness, crying attacks and diarrhoea are all possible
baby events when you’re on the road.

Many babies and toddlers find travel disrupting which doesn’t hurt them in
any way, but you might find their eating, sleeping and behaviour patterns
change temporarily.

You may wonder about using a sedative for your baby when travelling
overseas. Sedating healthy babies under two is not recommended as the
side effects of the commonly used drugs are considered to be too much of
a risk.

Nevertheless, some parents travelling overseas do take a mild sedative as a


back-up in case of difficult times but most find they don’t use it. The drugs
used for this are usually Vallergan and Phenergan, anti-histamine drugs
with a sedative effect available only on prescription. The risks with
medications such as these include extreme drowsiness and depressed
breathing or, alternatively, hyperstimulation and poor coordination. It’s
important to minimise the risks by carefully calculating the dose (check
with your pharmacist or doctor) and by using the sedative as a one-off
dose only; for example, once only on the plane and/or once only after you
get to your destination.

Sedating babies during a long car trip is not advised. It’s preferable and
safer to structure long car trips to fit in with the baby rather than the adults
and not have too many unrealistic expectations about the length and time
of your journey.

Try to avoid immunising your baby just before travelling.

Whether travelling by car, train or plane, the all-purpose baby bag is


essential. In it you need:

disposable or cloth nappies depending on the length of the trip;

disposable wipers or damp flannels in a plastic bag;

cleaning lotion;

nappy cream;

cotton balls;

extra dummies (if you are using dummies);

several changes of clothing;

muslin squares of various sizes;

safety pins, scissors, masking tape, torch, band-aids, tissues;


plastic bag for dirty clothes, nappies;

baby paracetamol, sunblock;

oral rehydration powder (for example, Gastrolyte). For emergencies


only. Unlikely to be needed for exclusively breastfed babies under six
months of age;

a blanket or sheepskin which can be used as a changing sheet or to put


on the floor so baby can lie on something familiar and clean.

Plane trip tips

Overseas (O) and domestic (D) flights


You can book a bassinet when you make your initial booking and
confirm this when confirming your flight twenty-four hours prior to
departure. Availability will depend on the type of aircraft, the class and
the number of babies on board. (O)

There is an 11kg weight restriction on babies in bassinets. Fresh linen is


supplied for bassinets at stopovers. (O)

Babies cannot be left in bassinets for take-off and landing. On all


Australian airlines they must be restrained on parents’ laps. This is done
by using a special baby seatbelt with a loop. The baby belt goes around
the baby’s waist; the adult belt is then passed through the loop and
secured. (O,D)

Babies not in bassinets, toddlers and children are not allowed to sleep
on the floor of Australian aircraft as unexpected turbulence can cause
severe injury, even death. (O,D)

Depending on the airline, baby/child car seats can be used on board as


long as they meet the airline company’s requirement for the standard
number (all car seats have standard numbers). A seat must be purchased
and airline staff will install it for you. Baggage check-in will check your
car seat to ensure it meets the standard number. Again it is crucial to
confirm this directly with the airline. (O,D)
Special meals must be ordered when making the booking and
reconfirmed directly with the airline, not via travel agents, to ensure the
message has got through. If a flight has been delayed or changed
unexpectedly a meal order may not be met. (O)

All aircraft have change tables located in toilets and for the sake of
fellow passengers it is good manners to use the change table to change
nappies rather than the cabin of the aircraft for the sake of both hygiene
and smell. (O,D)

If you have any concerns it is always advisable to check directly with


the airline prior to your flight. Different airlines have different rules,
requirements and services for travelling with babies so make sure you
are familiar with the system of the company you are using. It is also
recommended that you reconfirm anything you need to know at each
sector of your journey. (O)

Slimline umbrella strollers can be taken on board as long as they are


lightweight and compact. If the one you take is too large it may be
taken away at the aircraft door but will be available for you again when
you disembark, again at the door. (O,D)

If you are formula feeding it’s best to take cleaned, disinfected bottles,
formula powder and your own cold water (in a clear container or
bottled still water, not mineral water) and make up feeds as you go.
(O,D)

Make sure all your supplies are in see-through containers or they may
be removed from you at security—poor baby. You also may be asked to
take a sip from the water(!). (O)

Remember that if you ask for bottles or baby food to be heated on


airlines it will be heated with boiling water so try to think enough ahead
to allow the formula or food to cool down. Most babies don’t mind
cold/room temperature milk and food. (O,D)

Make sure you have plenty of nappies and supplies of formula. Most
airlines carry small supplies of these items but they may not be suitable
for your baby and supplies often run out. (O,D)

Babies and toddlers often get distressed on ascent and descent because
of the pressure build-up in their Eustachian tubes (the tube that runs
from the nose to the ears), which they don’t know how to relieve by
deliberately yawning. Sucking or crying will relieve the pressure.
Sucking is obviously the less distressing option for you and your fellow
passengers so the breast, a bottle, a dummy or your finger all fill the
bill. If your baby is really sound asleep and showing no signs of distress
there is no need to wake her in order to get her to suck on something.
(O,D)

If your baby or toddler has a history of ear infections and/or a mucousy


cold prior to departure it is a good idea to ask your family doctor to
check her eardrums. (O,D)

When you get to the other end you might find your baby comes down
with a minor illness (cough, cold or diarrhoea) which unfortunately
often seems to happen when babies leave their usual environment.

Re-organising sleep patterns might be tricky for a short time. Get your
baby back into her normal sleeping patterns as soon as you can by
keeping her up when she would normally be up during the day rather
than letting her sleep for long periods.

Car trips
Some babies travel well in their restraint or car seat for long stretches.
Others only manage two-hourly stints without becoming irritable.
Unfortunately a small number of babies go into full roar after departure
and continue until the car stops and they are taken out. It’s very hard to
know why some babies do this—one of my children carried on in this
fashion for a year or so which meant our car travel was quite limited until
she changed.

Have your baby dry, comfortably dressed, well fed and if possible ready
for a sleep before leaving. Make sure she is protected from the sun.

Long car trips are tiring for everyone. Plan to stop every two hours for a
break. What do you do if your baby has a sudden screaming attack and you
can’t pull over?

Sing a song, play a tape or turn up the radio.


If someone is available, rub your baby’s head, stroke her arm and
soothe her as much as possible.

Give a young baby a finger to suck. Try to distract an older baby with a
toy, finger food or a drink.

Obviously, stop as soon as you can.

It’s always worth asking well-travelled friends for tips. Extensive


travelling with your baby is best avoided until early difficulties with
feeding, crying, sleeping and so on are sorted out, although if it’s
unavoidable it won’t hurt your baby—it just makes things a bit harder for
you.

FOR MORE INFORMATION


Chapter 11: Daily Care (sharing beds)

Chapter 14: Sleeping and Waking in the First Six Months (‘sleeping through’)

Chapter 28: Sleeping and Waking Six Months and Beyond (options for night waking;
teach-to-sleep)
Part III:
6–9 Months
Chapters:
23. Equipment

24. Feeding Your Baby

25. Common Worries and Queries

26. Growth and Development

27. Safety

28. Sleeping and Waking—Six Months and Beyond

{ Return to Table of contents }


23

Equipment
Part III | Contents | Next chapter
Clothes
You are probably noticing now that your baby moves all over her cot at
night, rarely staying under the covers, which, if it’s winter, is a bit of a
worry. As soon as this starts to happen it’s a good idea to buy one or two
walk-in sleepers (sleeping bags with legs). A walk-in sleeper is worn over
pyjamas. It zips up the front and keeps your baby warm without restricting
her movements.

A highchair
The major piece of equipment to consider in this age group is a highchair.
Types and prices vary tremendously with new styles constantly available.

Here are some guidelines about what to look for:

Safety
Check stability. Highchairs with a narrow base may be less sturdy—this
particularly applies to older, secondhand highchairs.

Highchairs come with a waist and crotch harness, but it is advisable to


purchase a shoulder harness to use as well so there should be points on the
highchair for you to anchor it.

A portable chair that hooks onto a table is a useful accessory for holidays
and dining out or to use attached to the family table at home. Portable
chairs don’t fit all tables, so check when you buy. Babies can’t manage
portable chairs until they can sit well without support for a reasonable
period of time. A harness should always be used and constant supervision
is essential while the baby is in the chair because she has access to
everything within her reach on the table, so the risk of scalds and inhaling
small objects is increased.

The highchair should be made of non-toxic material. The simpler the


design, the easier to clean and the less likelihood of small fingers
becoming caught. Highchairs which convert to lowchairs should do so
smoothly without the risk of pinching fingers or jamming midway.

Practicalities
The highchair should be light and easy to move.

Think about the space available—you might need a fold-up model to


stack away when not in use.

The style of highchair that converts to an armchair, swing, potty and


table won’t be particularly useful unless it converts quickly and you use
all its features.

A few tips when using a highchair


Remember, it’s quite normal for many babies to be just beginning to sit
on their own around nine months. Until they can sit well independently
for any length of time they need support while in a highchair and
should only be left sitting supported for a limited time as they do get
tired and upset when they start to slide forwards or to one side.

Always make sure your baby is secure and never leave her alone with
food.

Take her out when she is obviously restless or upset.


24

Feeding Your Baby


Previous chapter | Contents | Next chapter
More about food—seven to twelve
months

Between six and nine months (depending on when you started food other
than milk) babies can be introduced to a wide range of food. On the
following page is a plan for you to use as a guide if you need one.
Remember, it is only a guide and must be adapted to your baby and
your lifestyle. The times given are approximate.

Here is some information to help you with the diet plan:

Babies who like eating will be following this plan by nine months.
Don’t rush things unnecessarily—on the other hand, there’s no need to
delay introducing a wide variety of food if your baby is enjoying it.

If allergy is a consideration for you, follow recommendations from your


adviser. If you are thinking of restricting your baby’s diet in any major
way, please seek advice from a knowledgeable health professional so
your baby’s diet is not nutritionally unsound.

Offer the food before milk from now on if you have been doing the
reverse.

As well as changing from four-hourly feeds to three meals a day, this


plan suggests gradually cutting down the breast or bottle feeds to three
every twenty-four hours. This will suit lots of mothers and babies but
obviously not all.

Morning Breastfeed/Bottle feed


6 am

Breastfeed or bottle (180–210ml)

Breakfast
8 am

Weet-Bix

VitaBrits

Porridge

Baby Cereal

(add made-up formula or full-fat milk)

OR

Stewed fruit

OR

Full-fat yoghurt

OR

Egg yolk (whole egg after nine months)

Morning Tea (optional)


10–11 am

Choice of finger food:


Bread

Cheese

Fruit rusk

Lunch
12.30 pm

Any vegies (mashed or ground in a handblender)

ADD

Any meat

ADD

Grated cheese (stirred in) or tomato puree or grated hard-boiled egg


yolk (no egg white)

Afternoon Tea (optional)


2–4 pm

Same as morning tea

Evening Meal
5–6 pm

Avocado and cottage cheese mashed

OR

Mashed banana & yoghurt

OR

Tofu & fruit


OR

Jars of commercial baby food

OR

Fresh yoghurt & fruit

OR

Egg (boiled or scrambled)

OR

Family food ground up (e.g. pasta, rice, casseroles)

Drink: breastfeed or bottle (180–210ml)

Breastfeeding
If you wish to breastfeed more often, continue in the way that suits
you and your baby. Or if you decide to only breastfeed three times a day
the feeds do not necessarily have to be given according to the plan—again
do what suits you both best.

Bottle feeding
Three bottles of milk a day is all your baby needs once she is eating well.
Water at other times is sufficient when your baby is thirsty. Leave your
baby on the formula she is already having—changing to follow-on formula
is unnecessary, unless it is cheaper. Note that the number of bottles and
amounts of formula recommended on the sides of the tins are the
maximum and do not take into consideration any other food babies might
be eating. You do not have to try to force your baby to drink the quantities
stipulated by the formula companies.

Night feeding and morning waking


Generally, night feeding, whether breast or bottle, is more related to
‘sleep’ than hunger, once babies are over six months.

If you wish to change your baby’s night-time feeding patterns, please refer
to Sleeping and Waking Six Months and Beyond in chapter 28. If you are
happy to continue the night feed(s), carry on.

If your baby is a 5 am waker, it is easier to give her the breast or bottle


at that time than launch into breakfast at the crack of dawn. Often, after
a milk feed babies go back to sleep for a while. When your baby has
breakfast later after an early feed there’s no need to repeat the bottle or
the breast—a little water from a bottle or a cup with her breakfast is all
that’s needed.

If your baby is a 7 to 8 am waker, give her breakfast as soon as she


wakes up followed by breastfeed, her bottle or milk from a cup.

Some breastfed babies whose mothers have an abundant milk supply do


not want breakfast after their morning breastfeed. The breastmilk
supplies all they need so don’t worry if your baby does this—she will
probably start eating breakfast some time around twelve months.

Think of your baby now as having family food rather than a special
diet. Take a critical look at the family diet; if you have a healthy diet,
your baby’s diet will be healthy too.

Food to avoid
Avoid junk food and unnecessary sugar (sometimes a little sugar on the
morning cereal helps with constipation). On the other hand things like
basil, garlic and tomato puree that you use in your food are fine.

Honey is a form of sugar and therefore can be a problem if given too often.
It has been known to cause botulism (poisoning by toxins produced by a
harmful bacteria) in babies under twelve months, so if you occasionally
use honey on bread wait until your baby is over a year old.

Other food to avoid includes whole apple, whole carrot, raw celery, corn
chips or popcorn because of the risk of choking. It is now recommended
that these foods not be given until children are over four years.
On the rather confusing subject of allergy and food intolerance, see
chapter 18.

A word about fats


Between birth and age two, fat is needed as a concentrated source of
energy, and for brain development. Fifty per cent of a baby’s energy intake
should come from fat during these years.

Birth to two years: During the first year use breastmilk and/or infant
formula and, after solids are introduced at six months, full-fat dairy
products in meals. During the second year, continue breastfeeding
and/or full-fat milk as the main drink and full-fat dairy products. Give
the milk from a cup instead of a bottle.

If for some reason you are eliminating dairy food from your baby’s diet
and you are not breastfeeding, use one of the soy infant formulas rather
than soy drinks as they have added fat.

Salt
Sodium intake should be always low but in the first year of life it shouldn’t
be used at all as babies have a limited capacity to excrete excessive
sodium, which may cause kidney damage. Don’t add salt to your baby’s
food.

Cholesterol
Cholesterol is a fat found in blood and is used by the body to make certain
hormones as well as nerve and brain cells. Most blood cholesterol is made
within the body from food containing saturated fats or cholesterol. High
levels of blood cholesterol can cause fatty plaques to form on the walls of
blood vessels that, in adult life, can break down or develop clots on their
surface and eventually block off arteries, causing serious disability or
death.

Food high in saturated fats, for example, deep-fried food and fatty meat,
are the main culprits for raising blood cholesterol. Foods that actually
contain cholesterol—for example, eggs and prawns—don’t play a major
role so it is fine to give your baby an egg a day if she likes them once she
is over nine months and is not allergic to them.

Food safety
Food safety precautions are very important as soon as your baby starts
eating family food. Small, hard items such as peanuts, pips and seeds are
dangerous for babies. This means taking care with pips in fruit and seeds
in bread. Offer plain bread and keep all nuts out of your baby’s reach.
Once your baby starts eating food herself, make sure she is always
supervised and not allowed to crawl or walk with food.

Gagging and choking


Most parents worry about the way their baby gags at times and the
possibility of her choking, and often confuse gagging with choking. It’s a
normal worry but unfortunately it can lead to a baby’s diet being too
restricted and the delaying of finger foods at the ideal time to start them
(between six and nine months).

What’s the difference?


1. Gagging: Babies are born with a strong gag reflex which is part of their
bodies’ natural defence against food entering the respiratory tract instead
of the oesophagus. The gag reflex persists throughout life—for example, if
you are forced to eat something you don’t like, you will automatically gag.
Babies have to learn to inhibit their involuntary gag reflex when they start
eating finger foods or food of a lumpier consistency than they are used to.
They also have to learn how much food to put in at a time when they feed
themselves—biting off more than they can chew is common. The other
common thing babies learn to do to confuse the issue is to gag
intentionally when they don’t wish to eat something. The ‘gagging on
purpose’ habit can last well into the toddler years, making parents believe
their toddler is physically unable to eat anything other than a liquid diet
(and forgetting about the times a chocolate biscuit or a packet of chips
goes down without a problem).

When a baby gags, the food sits at the back of her throat and ends up either
going down where it’s supposed to go or coming up again. As long as you
are around to make sure she’s all right and the food doesn’t get stuck,
gagging is harmless and part of the way she learns to feed herself and eat
lumpier food. Most babies need the main part of their meal ground up until
they are twelve months old as the gag reflex remains strong and, to some
extent, involuntary until then, so lumpy food from a spoon tends to make
meal times stressful because the lumps cause a lot of gagging. Mothers are
constantly told to offer lumpy food from a spoon from six months on with
dire warnings of babies never learning to chew if they don’t. I find this a
cause of great stress for many families. Oddly enough when babies feed
themselves finger foods they control their gag reflex much more
efficiently, so a good compromise is to give your baby the main part of her
meal ground up, then offer her some finger food she can eat herself.
Obviously if your baby manages chunky food from a spoon without
gagging a lot, go for it!

2. Choking: Choking occurs when the airway is obstructed, preventing air


from reaching the lungs. When it is a small, soft item (a crumb or a soft
lump) the baby will usually cough, which removes the object from the
airway. Serious obstruction happens when the item is a small, hard object
like an orange pip, a peanut, a lolly or a piece of apple which gets ‘stuck’
in the airway and partially or completely blocks it.

First aid for choking:


Check first if the baby is still able to breathe, cough or cry. If she is
breathing, coughing or crying, she may be able to dislodge the food by
coughing.

Do not try to dislodge the food by hitting the baby on the back because this
may move the food into a more dangerous position and make her stop
breathing.

Stay with the baby and watch to see if her breathing improves.

If she is not breathing easily within a few minutes, phone 000 for an
ambulance.
If the baby is not breathing:
Try to dislodge the piece of food by placing the baby face down over
your lap so her head is lower than her chest.

Give the baby four sharp blows on the back just between the shoulder
blades. This should provide enough force to dislodge the food.

Check again for signs of breathing.

If the baby is still not breathing, urgently call 000 and ask for an
ambulance. The ambulance service operator will be able to tell you
what to do next.

These guidelines are from Kids Health at the Children’s Hospital,


Westmead and Sydney Children’s Hospital, Randwick, with grateful
acknowledgement to the Women’s and Children’s Hospital in Adelaide.

N.B.: It is very difficult to learn basic resuscitation techniques from a


book. Courses are available in your state from the Royal Life Saving
Society, the Red Cross and St John Ambulance and learning and/or
updating your skills is always a very worthwhile thing to do.

If you have an emergency and you don’t know what to do, take the baby to
the phone and ring the Ambulance Service on 000 (everywhere). The
trained operator will give emergency instructions over the phone.

It must be emphasised that choking is not a hazard normally associated


with introducing a wide range of food to babies over the age of six months
as long as you take a few sensible precautions. Don’t let fear of choking
put you off allowing your baby to try different food and different ways of
eating.

Teeth and food


The first teeth emerge any time between three-and-a-half and sixteen
months. The arrival of teeth has nothing to do with when and what your
baby eats. Many twelve-month-old babies with no teeth eat a wide variety
of chunky food as they learn to use their gums very efficiently.
Breakfast suggestions
You may give your baby regular cereal (for example, rolled oats, Weet-
Bix, VitaBrits) after seven months or continue with baby cereals if you
prefer, or use both for variety. Whole, full-fat cow’s milk is fine to use on
the cereal. Cooked fruit may be added to the cereal or yoghurt and fruit
can be offered at times instead of cereal.

Egg yolk may be commenced any time after six months, the whole egg
around nine months. Soft-boil an egg and try the yolk off a spoon or dip a
finger of bread or toast into the egg and let your baby suck or chew it. A
hard-boiled egg yolk can be grated and mixed into her vegies at lunch or
dinner. Try scrambled egg with a little milk. Reactions to eggs include
mild swelling of the lips, a rash around the mouth and sometimes
vomiting. A small number of babies have life-threatening reactions to egg
(usually the white of the egg). See Food allergies and food intolerance,
chapter 18.

Try giving your baby fingers of toast or bread after breakfast.

Morning and afternoon tea


When you are changing from four-hourly feeds to three meals a day you
might find a snack and a small drink a handy substitute while your baby is
getting used to her new routine. It can also provide distraction from the
breast if you are limiting your breastfeeds to three a day. Morning and
afternoon tea is optional and if your baby sleeps or is quite happy without
a snack at this time, forget it.

Lunch suggestions
The main meal (that is, the vegie one) may be given in the middle of the
day or in the evening. There is no truth in the rumour that ‘heavy’ food
shouldn’t be given in the evening. If your baby is a non-vegie eater,
substitute vegies with some of the breakfast or dinner ideas.

Dinner suggestions
I think everyone has trouble at times working out what to give for the third
meal. Babies don’t need endless variety and cooking lots of separate little
dishes that may not get eaten is time-consuming and stressful. Remember,
babies who eat anything will eat easily prepared family foods and babies
who are fussy eaters usually won’t eat the specially prepared fancy baby
dishes made to tempt them, so keep it simple. Your baby may start eating
some of your food that is suitable for grinding up such as casseroles,
stews, pasta, rice dishes or spaghetti. Obviously avoid hot things such as
chilli, pepper and so on.

By nine months some babies are able to eat finger food such as sandwiches
and cheese on toast, however, many can’t cope with this sort of food until
they are around a year. Sandwiches can be made with a variety of fillings
such as banana, cream cheese, tomato, paté, Vegemite, salmon or tuna, and
cheese. Water may be given with dinner and the breastfeed or bottle saved
for bedtime if that’s what you and your baby prefer.

Juice
Juice is not necessary and an overabundance of juice sipped throughout the
day and night in bottles and straw and spout cups in the last thirty years
has led to an increase in toddler tooth decay because the juice is being
consumed in a way that makes it pool around the teeth, bathing them with
sugar that forms plaque, a sticky film that bacteria adhere to. Juice tends to
be given to babies and toddlers for a range of reasons that have nothing to
do with nutrition—relieving their boredom, getting them to sleep and
stopping them from grizzling. Sucking from bottles is extremely habit-
forming and hard to stop if it continues into the toddler years and fluid
from cups is never offered. Endless bottles of juice or milk not only cause
diarrhoea (juice), constipation (milk) and tooth decay, but interfere with
babies’ and toddlers’ appetites and prevent them from developing healthy
eating habits which are a part of normal weaning.

Occasionally juice is useful for babies who are constipated (see chapter 19
). One drink of juice a day is reasonable in a cup to be drunk in one sitting.
If you offer it straight after a meal, the vitamin C helps iron absorption.
Juice is problematic when it is offered in bottles or cups with teats or
straws over several hours, or worse, overnight.

Water
Water is the ideal drink for babies and toddlers and if they are truly thirsty
they will drink it, especially if juice is not immediately offered as an
alternative. Town water is best as it contains fluoride and is relatively
inexpensive. Bottled water, one of the crazier innovations of the last
twenty years, has no fluoride, no advantages over town water and is a
waste of money. Mineral water has high levels of salt and other minerals
and is definitely not recommended for babies, toddlers or kids of any age.

Whole cow’s milk


Unfortunately the issue of milk seems to have got completely out of hand,
to the point where it is viewed by many as akin to some sort of nasty
poison, drops of which should never pass babies’ lips. Manufacturers of
infant formulas have a lot to gain from the move to encourage the
prolonged use of formula. The general recommendation is to use formula
for the first twelve months, but toddler formula designed for the next two
years is widely advertised and available. The emphasis on the use of
formula means many parents today assume manufactured milk is an
essential part of infant feeding for at least the whole of the first year and
maybe beyond.

Many babies bypass formula by breastfeeding and, in the second six


months, combine breastfeeds with milk from a cup.

Why the recommendations? What are the problems


with whole cow’s milk?
When babies under six months are not breastfed or have a combination
of breastmilk and formula, formula is the best and safest option to put
in their bottles. Whole cow’s milk lacks ingredients which are essential
for a young baby’s proper growth and development when it is
supplying their total food requirements. Whole cow’s milk is also not
suitable for babies over six months as the major part of their diet. A
large amount of whole milk in conjunction with little or no food is
obviously nutritionally unsound for babies and toddlers. This does not
mean babies cannot have whole milk as part of their diets, in a cup or
on cereal, once they are over six months.

Allergy/intolerance is a problem for a small number of babies


(intolerance is more common than allergy). Some babies can tolerate
cow’s milk formula but when introduced to whole cow’s milk in any
volume may vomit, get cramps and perhaps a shiny red bottom
(probably due to the lactose). Other babies may get constipated
(probably due to the protein). Some babies with cow’s milk
allergy/intolerance cannot drink cow’s milk (or soy) formula either—
naturally it would not be a good idea to give these babies whole cow’s
milk.

Research has shown that whole cow’s milk plays a part in contributing
to iron deficiency in a small number of vulnerable babies and toddlers
when it is started early and used excessively. Iron deficiency is cause
for concern, but is more strongly associated with poverty, fad diets and
ignorance. Whole cow’s milk has a relatively low iron concentration
and has been found to cause minuscule bleeding into the gut (detectable
only by a special test) which increases the chance of iron deficiency in
these babies. This information has been used widely to justify the
prolonged unnecessary use of infant formula, particularly follow-on
formula, for all babies rather than the small number who may need it.
Formula certainly contains mammoth amounts of added iron, only 4 to
10 per cent of which is absorbed by the baby. Babies who eat well will
get good iron from natural sources such as red meat, chicken and fish,
legumes and grains. Citrus fruits, cauliflower, broccoli and melons
provide vitamin C to help efficient iron absorption.

So, it’s fine to include small amounts of full-fat whole cow’s milk in your
baby’s diet (on her cereal or in her food) after six months. If she is bottle
fed, continue to use formula in her bottles until twelve months, when you
can change to full-fat whole cow’s milk. If she is breastfed and starting to
use a cup or straw, whole cow’s milk is fine to use in the cup from six
months of age—you do not have to go out and buy formula.

Whole cow’s milk is preferable to soy drink as it contains naturally


occurring ingredients necessary for good nutrition (for example, fat,
calcium and iron) that are not present in unfortified soy drink. It is now
recommended that soy drink not be used until after age two. If for some
reason you are giving your baby soy drink, use a fortified infant formula.
See chapter 7 for more information about the use of soy formula.
Babies who will only eat commercial food
This is another cause of anxiety for some mothers. Try not to worry.
Remember you can’t force babies to eat things they don’t want to eat.
Commercial food is nutritious and there’s an incredible array around now
to choose from. Stop cooking your own food if your baby is not eating it
and the situation is becoming tense. Give her what she likes, but as soon as
she can sit for a while in a highchair follow the jar of food with some
finger foods for her to eat herself. Offer some fresh easy food (fruit, bread,
cheese, tomato, cucumber) regularly.

Teaching your baby to use a cup


Drinking from a cup is a skill that has to be learnt—it is not a
developmental milestone that suddenly happens at a certain age. Teaching
babies to drink from cups takes time and patience, but there are lots of
advantages for you and your baby should you decide to teach her to use a
cup during her first year.

Once she’s drinking well from a cup the bottles can go, so there’s one
less hassle for you to worry about.

Bottles of milk do interfere with the eating of food and in the second
year when lots of babies become fussy eaters, bottles of milk and juice
become a quick fix for feeding difficulties at a time when eating should
be encouraged, not drinking.

The risk of tooth decay is increased the longer the bottles are used.

Going directly from breast to cup is the only option for breastfed babies
who don’t like bottles.

Here are some tips if you would like to teach your baby to drink from a
cup.

N.B.: The definition of a cup is any container that does not have a teat on
it.

As all babies are different you need to experiment to find out what suits
your baby best—a small cup, a spout or a straw.
A small cup is often the most successful to start with. Start with two
teaspoons of fluid only. If you fill up the cup your baby will be drenched
and you will quickly lose patience. The main aim in the beginning is to
gently teach your baby what to do, not to try to get her to drink the same
amount she has from the breast or a bottle. Offer her a small amount in a
cup at morning or afternoon tea time or after one of her meals. Use
breastmilk, milk or water.

The more she has the opportunity to practise, the better she will become at
drinking. The amount she drinks steadily increases; it takes about six to
eight weeks for a baby to learn to drink 60–80ml in one go. Naturally, you
have to hold the cup!

You might like to try a cup with a spout as they are less messy, however I
find spouts don’t suit a lot of babies because they suck them like a teat and
end up coughing and spluttering a lot.

Straws can be very successful once the baby gets the idea. Start by offering
one of the water packs that comes with a straw. Show your baby what to
do, then put the straw to her lips and squeeze the pack so a little water
squirts out to encourage her to suck on the straw. Practise whenever you
can. One day she will go ‘sip’ and get such a surprise she will probably
open her mouth and let the fluid drop out. Once she’s got the idea of
sipping, keeping her mouth shut and swallowing, buy one of the cups
available with a built-in straw. These have the great advantage of not
spilling everywhere.
Breastfed babies going from breast to cup never consume the quantities of
fluid bottle-fed babies consume, so if you have a breast-to-cup baby don’t
panic about this. There is rarely any need to force a healthy, breastfed baby
to take a bottle after six months of age. This includes babies who only
have three to four breastfeeds every twenty-four hours. Babies following
this plan thrive on their meals, steadily increasing amounts from a cup,
spout or straw and their breastfeeds.

While spout and straw cups are extremely useful and help enormously
with the mess factor, tooth decay is a risk if your baby or toddler sips at
one continuously through the day unless they only contain water.

Vegetarian diets for babies


Many families now choose not to eat meat. A vegetarian diet that includes
milk, eggs and other dairy products is fine for babies too.

Vegetarian diets that do not include any animal fats (vegan diets) pose
problems for babies and young children as these diets tend to be bulky and
offer a very limited range of food, which small people with fussy appetites
are likely to have difficulty with. A continuing shortage of protein, vitamin
B12, iron, calcium and fat as well as an overall shortage of calories can put
a baby or toddler’s growth at risk. Some of the problems can be overcome
by breastfeeding and/or using a soy infant formula, mixing liberal amounts
of smooth peanut butter (unless your baby is high risk for allergy) and
tahini (sesame seed paste) into dishes before serving and giving a vitamin
B12 supplement. The use of a soy infant formula (as opposed to soy
drinks) should be continued for the second year and when replaced by a
soy drink, a brand should be chosen that has added fat, calcium, B12 and
iron.

Premature babies
Premature babies can follow the same dietary guidelines, although babies
born earlier than thirty-four weeks will take longer to get to the stage of
sitting and eating finger foods. Babies born very early may not be ready
for the diet sheet in chapter 24 until about nine to twelve months, but all
premature babies should be offered a variety of foods including finger
foods by twelve months. It is fine to teach premature babies to drink from
a cup any time in their second six months as well as cutting down the
number of bottles they have as suggested in the diet chart. The information
for breastfed premature babies at this stage is the same as for full-term
babies.

Recipes
Not everyone has the time or energy to prepare special baby recipes. Not
all babies will eat their delicious home-cooked meals. However, for the
mothers and babies who would enjoy the process, please refer to the recipe
section at the back of the book.

FOR MORE INFORMATION


Chapter 25: Common Worries and Queries (flexible sleeping and eating guide for six months and
beyond)

FURTHER READING
Baby & Toddler Meals, Robin Barker, Pan Macmillan Australia, 1998.
25

Common Worries and Queries


Previous chapter | Contents | Next chapter
Funny habits
Babies have lots of funny little habits that are either related to reflexes
which they have no control over or the normal changes happening to their
bodies as they grow. Other funny habits are part of babies’ inbuilt urges to
explore their own bodies and the world around them. Whenever they are
tired or bored they become more obsessive and frantic about the particular
strange habit they are into. Mothers often notice that the behaviour often
stops when their babies are out and about being entertained and distracted.

Here are some examples of a few interesting actions and activities


common to all healthy babies—none of them are anything to worry about
unless there is a whole range of odd behaviour accompanied by signs of
illness.

Pulling and rubbing ears is a common action from six months and is not
a sign of an ear infection or ‘teething’. Once your baby discovers her
ear it becomes a fascinating pastime to play with it because it makes an
interesting sound and it’s fun to grab hold of. If your baby is into
pulling and rubbing her ears you may notice she does it more when she
is bored or over-tired.

Head-banging is another habit some babies indulge in, especially just


before sleep. Try not to get disturbed by head-banging or to get worried
by people who tell you it indicates baby anxiety. Try to avoid long
hours of boredom on the home front by getting your baby out and about
as much as possible. Like all the other actions it stops eventually.

Sometimes you might notice your baby coughs almost deliberately even
though she has no sign of a cold—another funny little habit which
shows your baby has reached an age where she imitates and does things
on purpose. Often, once a parent realises what’s happening, he or she
coughs back which encourages their baby to do it again so it becomes a
game.

Babies find their tongues fascinating parts of their equipment and many
babies go through stages where they keep sticking out their tongues.
Adults often find this amusing and do the same thing back so the
tongue-sticking-out game is as popular a pastime as the coughing game!

Some babies make a peculiar grunting noise deep in their throat.


Making a similar noise is quite irritating to adult throats but babies
manage to do this continually without any ill-effect. Grunting noises in
healthy babies is not a sign of constipation, bowel or tummy problems
—just another strange habit that passes.

Another habit is sucking the top or bottom lip, which looks most
peculiar but is harmless.

Babies often find constantly opening and shutting their hands is an


interesting occupation which can develop into a habit for a while.
Another common hand habit is to sit moving hands and wrists as if
driving a motor bike.

Ear-piercing screeches are fun and often repeated over and over again.
If the screeching and squealing gets a bit much, tell your baby firmly
and consistently, ‘no’ every time she does it. Eventually she will stop. If
you keep laughing and encouraging her to do it the screechy habit will
last longer.

Rubbing eyes is another common habit. As long as your baby is


otherwise well and her eyes are not excessively watery, red or have a
discharge, rubbing eyes is not significant.

Babies repeat all sorts of actions. These are just a few normal habits,
disappearing as they grow to be replaced by others. Don’t try too hard to
interpret them by projecting deep and meaningful adult thoughts onto
harmless baby habits.

Routines—one last time


Here’s a flexible guide for six months and beyond if you are looking for
one:

5 am – 6 am: Breastfeed or bottle.

7 am – 8.30 am: If your baby sleeps this late, offer her breakfast as soon
as she wakes (choose something from the diet sheet in chapter 24) before
her breastfeed—give her a breastfeed straight after her food.

9 am – 11 am: Bed—after some morning tea (if she wants it—see diet
sheet). Baby may sleep from forty minutes to two hours.

12 noon – 1.30 pm: Make sure she’s up by 1.30 at the latest—it’s okay to
wake her. Give her lunch—choose something from the diet sheet and give
her a breastfeed, bottle or cup after her food.

2 pm – 3 pm: Bed but make sure she’s up by 4 pm and keep her up until
bed at 7 or 7.30 pm. Baby may sleep forty minutes to two hours.

4 pm: Afternoon tea (if she wants it). You’ll probably need to devote this
time to amusing her or going for a walk.

6 pm: Dinner—choose something from the diet sheet.

6.30 pm: Bath followed by breastfeed or bottle.

7 – 7.30 pm: Bed—if you are having trouble helping your baby to go to
sleep and it is bothering you, read chapter 28 and follow the ‘teaching-to-
sleep’ guidelines which will teach her to go to sleep without the breast or
bottle.

Total sleeping in the day varies from one to three hours. Changing from
two to one daytime sleeps happens any time between nine months and
fifteen months and depends a lot on what time the baby wakes in the
morning. Babies who catnap (only sleep for thirty to forty-minute
stretches) do better having several small sleeps throughout the day. Trying
to ‘make’ babies who catnap sleep for longer periods is usually not
possible. For more on sleep, see chapter 28.

‘Spoiling’ and discipline


Between six and twelve months babies gain skills which make them
mobile and keen to explore and this is the time you will find you have to
start to set limits, to discipline. Discipline means to guide, to teach, to lead
by love and example. Discipline does not mean withholding love,
smacking, shouting or imposing rigid rules. Babies of this age need a few
reasonable limits so they can begin to understand how their world
operates, to develop healthy eating habits and to keep them safe.

At this stage limit-setting is centred around activities associated with


normal development. It is not centred on behaviour as babies don’t act in a
premeditated fashion and still have no control over their behaviour. So,
again ‘spoiling’ in the sense of turning a baby into a nasty person no one
likes is a meaningless expression. Not setting a few limits may lead to
injuries or, as the baby becomes a toddler, completely unacceptable,
exhausting antics which do not contribute to the parent’s wellbeing or a
loving home atmosphere.

Here are a few tips on limit-setting:

When saying ‘NO’, limit it to a few important things. Always say ‘NO’
in a firm voice that is different from your normal conversational tone.

Childproof your house and put away as many forbidden objects as you
can.

Try diversion when you want your baby to stop what she’s doing or
about to do.

Go out and about as much as possible. Babies quickly become bored at


home when they are not eating or sleeping. The need for limit-setting is
less when they are stimulated by new sights, sounds and people.

If your older baby’s antics are driving you mad, time out is acceptable
for short periods—her cot is the best place for this.

Work on a united front approach with your partner. Babies don’t


respond well to chaos and conflict on the home front.

Repetition and patience are essential, especially between the age of nine
months and three years, as it takes this long for children to start to
develop the ability to make sensible and safe judgements about their
behaviour and the possible consequences of their actions. Learn all you
can about baby and child development so you know if your
expectations and discipline are reasonable.
All babies and parents are different, so the limit-setting and discipline
practised will be different for each family. Babies thrive equally well and
grow into well-balanced young people whether the discipline is very
structured or more easygoing as long as their environment is safe, stable
and loving.

Nappy rash
Nappy rashes in older babies usually need a combination of a mild
hydrocortisone ointment and an anti-fungal cream to clear them up, so it’s
always best to seek advice from your child and family health nurse or
family doctor before buying out the pharmacy. A sudden bright red shiny
bottom can be the result of a dietary change. Whole cow’s milk, soy milk
or yoghurt can all have this effect and stopping or cutting down the
offending food clears the rash up. Antibiotics and a bout of viral diarrhoea
can also cause sore red bottoms. Red ‘weeping’ bottoms caused by food,
medication or viral diarrhoea need a good barrier cream thickly applied to
help them heal. Here are the two I find the best:

Ask your pharmacist to mix 1 per cent Ichthyol and 10 per cent zinc in
yellow soft paraffin.

Desitin ointment is made by Pfizer and I find it a marvellous barrier


cream for babies with sensitive skin who are prone to nappy rash. It
both heals and prevents nappy rash so it’s worth getting some in if your
baby has a sensitive bottom.

Common illnesses—six to twelve


months
Diarrhoea
Diarrhoea means that there are a lot of loose, watery bowel motions
different from your baby’s normal poo. Sudden diarrhoea is usually caused
by a viral infection of the gut. It may or may not be accompanied by
vomiting. Some gut infections cause vomiting without diarrhoea. It is often
confusing sorting out viral diarrhoea and vomiting from loose poo caused
by food or medication or other illnesses, so if you are ever in doubt, seek
help from your family doctor.

Medication is not a part of treatment for most infectious diarrhoea.


Antibiotics are only used occasionally for a specific, diagnosed bacterial
infection. Medications such as those adults take to stop diarrhoea are
dangerous for babies and should not be used. Simultaneous diarrhoea
and vomiting is potentially serious and needs medical assessment.
Diarrhoea or vomiting on its own usually only needs simple dietary
measures.

The correct treatment for either diarrhoea or vomiting is to give small


amounts of clear fluids only for twenty-four hours. If you are
breastfeeding, continue breastfeeding—if you have an abundant supply
try short, frequent feeds.

If you are bottle feeding or using a cup, the amount of fluid should not
exceed 5–7ml per kilo of the baby’s body weight every hour.

Suitable fluids
A commercial preparation such as Gastrolyte: make as directed.

Non-diet cordial (e.g. Cottee’s): one part cordial to six parts cooled,
boiled water.

Rice water: Boil ¾ cup of white rice in 1½ litres of water until the water
is milky—not too thick! Strain the rice and add four small flat
teaspoons of sugar to every litre of rice water.

Boiled water: Add four small flat teaspoons of sugar to one litre of
boiled water.

A few important points


A commercial preparation such as Gastrolyte is not a medication. It is a
fluid replacement to be given instead of formula for twenty-four hours.
Parents are often given confused messages about using a commercial
fluid replacement and give it as well as formula in the mistaken belief it
is a medication which will cure the diarrhoea.

Babies under four months should be given a commercial preparation


(Gastrolyte or similar) in preference to diluted cordial, rice water and
sugar or boiled water and sugar.

Older babies with simple diarrhoea or vomiting do not need commercial


preparations. Any of the other suggested fluids are suitable for older
babies.

Follow the guidelines for the addition of sugar closely. A small amount
of glucose or sucrose helps the baby absorb fluid more efficiently and
makes the fluid more palatable, but too much causes more diarrhoea.
Do not give flat lemonade at any age—the sugar content is too high.

After twenty-four hours of small, frequent breastfeeds or clear fluids,


reintroduce your normal breastfeeding regime or half-strength formula.

Older babies who are eating food should resume a balanced diet as soon as
possible, but continue to give frequent small amounts for a few days. Make
sure some fat is introduced during the second twenty-four-hour period (for
example, breastmilk, formula or milk) as constant clear fluids and fruit and
vegies alone aggravate acute diarrhoea.

Recommence full-strength formula by day three. Sometimes babies


develop a temporary lactose intolerance following gastroenteritis, which
means their watery diarrhoea comes back once full-strength formula or
milk is reintroduced. When this happens a lactose-free formula is required
for two to three weeks until the bowel recovers.

Breastfed babies tolerate breastmilk well following gastroenteritis, and do


not need lactose-free formula.

Most babies respond well to these simple measures, but unfortunately


there are times when the correct advice is not given or parents and health
professionals underestimate the severity of the illness.

Always seek help or a second opinion if:


You are worried.

You are given a diagnosis of ‘teething’ (growing teeth does not cause
diarrhoea).

Your baby is under three months of age.

Your baby suffers from other illnesses such as diabetes, heart disease,
urinary tract infections or is on any medication.

Your baby is simultaneously vomiting and having diarrhoea, especially


if she is not keeping down breastmilk or clear fluids.

Your baby is lethargic, drowsy, has a dry mouth and is passing less
urine than normal.

What about the well, happy baby with mild diarrhoea, no ‘burnt’ bottom,
no vomiting, no weight loss and no fever?

When this happens it is difficult to decide whether or not to start the


diarrhoea regime as the baby gets very cross and very hungry. Wait one or
two days and see what develops. Continuing loose poo in an otherwise
well baby can go on for some time after an episode of viral diarrhoea. It’s
inconvenient and messy but harmless and eventually stops.

N.B.: endless bottles of juice exacerbate loose poo. Try water when she is
thirsty.

Ear infections
Ear problems in older babies are very common.

The problems usually occur in the middle ear because the eustachian tube
which connects the middle ear to the throat is short and straight in this age
group. This allows easy entry of mucus, milk and germs into the chamber
of the middle ear. Older babies and toddlers also catch a lot of colds until
they build up some resistance to bugs. The extra mucus that colds create
blocks the eustachian tube, which stops the middle ear from draining
properly.
A problem with ears is caused by either:

1. An acute infection from infected mucus. This is painful so the baby’s


behaviour may change dramatically. She may have screaming attacks,
whinge more than usual or develop a sudden sleep problem. It’s always
worth having your baby’s ears checked when these things happen.
Antibiotics and pain relievers are needed;

2. A collection of uninfected mucus in the middle ear, called glue ear.


Glue ear is generally not painful but transient earaches occur, especially
at night, so a change in night sleep patterns may occur even when a
baby is happy during the day. Treatment for glue ear ranges from none
to medication to insertion of tubes depending on the frequency of
infections, the discomfort and the amount of hearing loss.

The universal immunisation of the pneumococcal vaccine has decreased


ear infections by 30 per cent and the requirement for grommets (miniscule
tubes inserted into the eardrum to allow air to enter the middle ear) by 20
per cent.

Urinary tract infection


A urinary tract infection (UTI) is caused by a growth of germs—usually in
the bladder but sometimes in the kidneys. It is common in babies, toddlers
and children. Approximately 30 per cent of urinary tract infections in
babies occur because of an underlying structural problem in the urinary
system. It is routine for all babies to have investigations (special X-rays)
and an ultrasound when a UTI is diagnosed to treat such conditions if they
are present to prevent chronic renal problems later in life.

Symptoms
Symptoms in babies and toddlers under three can be vague and confusing,
which is why urine is routinely tested when the cause of a fever is not
clear. Irritability, vomiting and failure to thrive along with night sleep
problems can also be symptoms of a urinary tract infection.

Sometimes the parent will notice odd-smelling urine or urine that looks
cloudy or thick and occasionally the baby may show signs of distress when
having a pee.
Treatment
A urine specimen is collected and tested and antibiotics commenced if an
infection is present. Collecting urine samples from babies can be a
challenge. An attempt is made to catch a clean sample of urine in a
suitable specimen jar (plastic urine bags are no longer used as
contamination causes unreliable results when the urine is tested). If this
proves too difficult, or if the baby is very ill, the urine may have to be
collected in hospital by inserting a fine tube or needle into the bladder via
the abdomen.

With the antibiotics, infections will clear in five to seven days, but the
baby may continue a smaller dose of the medication until the results of the
investigation are known.

Treatment for underlying kidney and bladder problems ranges from


protective antibiotics for a period of time to surgery, depending on what
the problem is.

Coughs
Coughing is a reflex we are all born with. Babies cough to clear their
throats, which helps clear their air passages. Coughing accompanies many
illnesses. When your baby has a cold the reason for coughing is obvious.
When coughing is associated with wheezing, a high fever, breathlessness
or sleepless nights see your family doctor. It is dangerous to give cough
suppressants to a baby or a young child. Worrying coughs should always
be investigated.

Croup
Croup is a form of laryngitis that follows a viral infection in the upper
respiratory tract and affects the voice box and trachea. It is more common
in babies and toddlers than in older children and adults because they have
small soft windpipes that collapse easily when inflamed. The baby’s cough
sounds like a baby seal barking and is accompanied by a crowing noise as
she breathes in. Her voice may be hoarse and she may have trouble
breathing.
Croup is more severe at night when the air is cooler and the worst period
usually lasts about two nights. Some babies have what is known as
‘spasmodic croup’—frequent attacks of a small duration. These tend to
occur at night lasting for a few hours and occasionally recur the following
night.

Treatment
The previous treatment of using steam to alleviate symptoms is no longer
recommended as the risks of burns and scalds far outweigh any benefits,
which have been shown to be negligible. Calm your baby as much as you
can by sitting her on your lap while the bout lasts.

Go to hospital immediately if:


You are worried about your baby’s breathing or sucking her chest right
in.

She becomes pale and sweaty or blue.

Croup is usually mild, but it can get worse quickly. If you are worried,
seek medical help.

Medications
As croup is caused by a virus, antibiotics are not appropriate. The only
medications used for croup are steroids and adrenaline, which are
administered in hospital.

Wheezing and asthma in babies under twelve months


Accurate diagnosis of asthma in this age group is difficult. Episodes of
prolonged coughing are common amongst babies and toddlers under two.
The endless cough is usually associated with upper respiratory tract
infections and is unlikely to be associated with asthma when there is no
wheeze or history of allergic conditions such as eczema, hay fever and
reactions to food. Some babies under twelve months have troublesome
episodes of wheezing but are otherwise thriving and happy. Most of them
lose the wheeze after the first year. Consult your family doctor if you are
worried about your baby’s coughing or wheezing.

Pneumonia
Pneumonia is a viral or bacterial infection of the lungs that causes swelling
and blockage in sections of the lung. It is also often referred to as a ‘chest
infection’. Pneumonia occurs at all ages but is most common in babies and
toddlers.

Symptoms
Pneumonia may follow a mild infection of the nose and throat. It can be
tricky to initially diagnose in babies as the symptoms vary greatly and can
be very subtle. For example, neck stiffness, lack of energy, fever and loss
of appetite (a baby’s sudden refusal to feed or disinterest in breast or bottle
usually means something is wrong). Other symptoms include rapid
breathing, grunting while breathing and a bluish tinge around the mouth. A
chest X-ray is usually needed to confirm the diagnosis.

Treatment
Antibiotics are used when bacteria is the cause of the infection. Serious
pneumonia needs hospitalisation for intravenous therapy to administer
fluids and antibiotics (if appropriate). Paracetamol is used for pain and
fever. Recovery usually takes seven to ten days.

With universal immunisation of the pneumococcal vaccine there will be a


20 per cent decrease in pneumococcal pneumonia.

Fevers
Babies and toddlers are much more prone to running fevers than older
children and adults are. Fever is the body’s natural defence against
infection (for example a cold, a urinary tract infection). Most fevers in
babies are caused by viral infections, but fevers can be caused by things
not related to infection such as over-dressing, being kept too long in a hot
car or crying for a long time. ‘Teething’ does not cause fevers. Mild fevers
that come and go over a period of time should always be investigated.

A fever is not the only sign of an illness. Some serious illnesses only cause
mild fevers. Older babies and toddlers can have relatively high fevers
(40°C) and still be active and eating and drinking well.

How do I take my baby’s temperature?


The regular glass thermometer remains the most accurate way to take a
temperature although it is sometimes difficult with a squirming baby. Try
to make sure the thermometer is well up into the armpit and surrounded by
skin. Hold the top of the baby’s arm firmly against her body for as long as
you can, ideally at least three minutes. If it is 37.5°C or higher, she has a
fever.

Most parents become skilled at estimating fever by touch. The best method
is to place the back of your hand on your baby’s tummy. You will soon
learn the difference between a warm, hot or burning feel.

What if her temperature is below normal?


Usually this is because the thermometer is not registering properly—not
because there is something wrong with your baby. If her body and head are
warm and if she is a good colour with good skin tone and a loud cry, there
is unlikely to be a problem. However, if she is pale and floppy and feels
cool to touch, seek help immediately.

What to do if your baby has a fever


From birth to three months all babies should be checked by a doctor for
any fever (37.5°C and over) unless the fever is directly related to
immunisation in which case the cause is known and it should run its
course and fade. Babies aged from three to twelve months with high
fevers (39°C) should also be seen by their doctors.

Mild to moderate fevers (37.5°C–39°C) do not necessarily have to be


treated if the baby is otherwise happy and comfortable.

If your baby is hot and irritable, undress her down to her singlet and
nappy and give a single dose of paracetamol or ibuprofen. Encourage
her to take extra fluids and consult your doctor if the fever does not
settle or you are worried (see When to call the doctor, chapter 10).

Fever fits (febrile convulsions)


A fever fit is a convulsion caused by a high temperature. The most
common age for this to happen is between eighteen and twenty-four
months, but overall it happens to about 4 per cent of all babies and
children aged between six months and five years.

Why does it happen?


Babies and young children have immature brains that are particularly
sensitive to outside stress. Some just can’t handle a high body temperature
so their brains respond by giving off an abnormal electrical discharge that
results in a fit. Having a fit means the baby loses consciousness and
twitches all over. It can happen out of the blue when it is not obvious that
the baby has a fever, however, there is usually a history of an illness such
as a bad cold, an ear infection, tonsillitis or sometimes gastroenteritis.
Urinary tract infections are less common, but can cause very high fevers
which is why a urine test is done when the cause of the fever is not clear.

What do you do?


It’s very scary but don’t panic! The fit usually lasts less than five minutes
but that can seem like forever when you’re the parent. Stay with your
baby. Place her on her side or tummy with her head on the side. Loosen
any clothes around her neck and gently support her head with your hands.
Don’t put anything in her mouth or force open her gums. Urgent medical
help should be sought if it lasts longer than five minutes.

When your baby comes around, take her to your family doctor or your
nearest children’s hospital as it is important to confirm that it is only a
fever fit. This may mean some tests being done depending on the age of
the baby and how long the fit lasted.

Febrile convulsions can recur. After the first convulsion there is a 30 per
cent chance of recurrence (50 per cent if the baby is under a year); after the
second convulsion a 50 per cent chance. Guidelines for babies/toddlers
with fevers who have histories of fever fits are the same as for any babies
or toddlers. Routine repeated use of paracetamol or ibuprofen for mild to
moderate fevers has not been shown to be useful in reducing the incidence
of febrile convulsions. Frightening though they are, febrile convulsions are
usually brief and harmless and when you know one may occur, you can be
prepared.

Infectious diseases
These are not common in a baby’s first year but do happen. Identifying a
rash as a particular disease (for example, measles, roseola, rubella, viral
rash or an allergy rash) is often an educated guess in the first year as
strange rashes at this time are not always easy to diagnose accurately.

The time between the infection (before the symptoms appear) and the
illness (when the symptoms appear) is called the incubation period.

Chickenpox
Chickenpox is preceded by a mild fever and a fussy baby. The rash starts
as small, raised pink spots which turn into blisters then form crusts. The
incubation period is fourteen to twenty-one days so there can be a three-
week gap between one family member and another becoming infected.
Parents often worry about the likelihood of their very young baby catching
chickenpox from older babies and toddlers. New babies can catch
chickenpox but their natural immunity protects them to a large extent so it
is unusual to see chickenpox in the first six months after birth.

Treatment aims to relieve the itch and fever. Give paracetamol and warm
to hot baths. Add some anti-itch solution such as Pinetarsol to the bath
water. Calamine lotion applied directly to the spots helps.

A vaccine is available for chickenpox and is highly recommended.

Measles
Measles immunisation is started at twelve months, but a small number of
babies do catch measles before they are immunised. If this happens your
baby still needs her immunisation at twelve months.

The incubation period is seven to fourteen days. Measles first appear as a


cold. The baby is miserable with a runny nose, watery eyes, a cough and a
fever. Two days later spots appear on the neck, behind the ears and on her
face.

Within hours the whole body is covered. The rash often joins together and
becomes one red mass or a series of blotches. Give paracetamol to bring
the fever down and encourage extra fluids.

Rubella (German measles)


Rubella immunisation is included with the measles, mumps immunisation
at twelve months. Rubella has an incubation period of fourteen to twenty-
one days. It is often difficult to diagnose in babies and is frequently
confused with measles, roseola, an allergy or a viral rash. The baby may
have mild cold symptoms. The rash rapidly spreads over her arms and
body. It appears as small, pink separate dots, unlike the measles rash
which is red and blotchy.

The most reliable sign confirming rubella is swollen glands at the back of
the neck and behind the ears.

Care should be taken to avoid contact with women who are in the early
stages of pregnancy as the rubella virus is dangerous to the developing
baby. The introduction of the rubella vaccine as part of the
measles/mumps/rubella immunisation, as well as the rubella immunisation
in high schools, has done a lot to eliminate the risk, but if there is any
doubt about the possibility of a problem your family doctor or obstetrician
should be consulted.

Roseola
Roseola is an acute viral disease which is most commonly seen in babies
between six and twelve months. The incubation period is about ten days.

Roseola starts with a sudden very high fever which remains for four to five
days. Just after the height of the fever a pale pink blotchy rash appears on
the chest and spreads to the arms and legs. It is rarely on the face. The rash
fades quickly, usually within twenty-four to thirty hours. Treatment
involves bringing the high fever down with paracetamol.

Whooping cough (pertussis)


Whooping cough is still around; partly because the immunisation only
gives 80 to 90 per cent protection, but mostly because there is a rise in the
number of parents (flat-earthers) who choose not to immunise their babies.
There are some pockets in Australia where the immunisation uptake is
very low, consequently the rates of pertussis are high which puts newborns
at risk.

Newborns are not immune until they have had their whooping cough
vaccine (two, four and six months), so it is advisable to keep adults and
children with coughs away from your baby until she is fully immunised
(some protection does commence with the first vaccine).

The rate of pertussis has increased in adults in the last decade or so and it
is strongly recommended that prospective parents, new parents,
grandparents, childcare workers and health workers top up their immunity
by getting whooping cough boosters.

If your baby has been immunised and does get whooping cough, the illness
is much milder and easier to manage. Whooping cough starts as a short,
dry cough with a fever developing a short time later. After a few days the
whoop develops and vomiting occurs. Small babies tend not to whoop but
have difficulty breathing and blue attacks. They are at great risk and need
hospital care so they can have round-the-clock attention. Even a mild case
lasts six weeks.

For more on pertussis go to www.immunise.health.gov.au

FOR MORE INFORMATION


Chapter 10: Early Worries and Queries (nappy rash)

Chapter 12: Safety (immunisation)

Chapter 15: The Crying Baby (lactose intolerance)


Chapter 19: Common Worries and Queries (recycled food in the poo)

Chapter 24: Feeding Your Baby (diet chart)


26

Growth and Development


Previous chapter | Contents | Next chapter
Growth
During the third three months of their lives lots of babies gain around 60 to
90 grams (2 to 3oz) a week and between six months and twelve months
will grow 8 to 10cm (3 to 4 inches).

AT NINE MONTHS
Small/Normal Large/Normal

Weight 7.5kg (17lb) 11.6kg (24lb)

Boys Height 67cm (26 inches) 78cm (29 inches)

Head circ. 43cm (16 inches) 48cm (18 inches)

Weight 7.0kg (15lb) 10.8kg (22lb)

Girls Height 65cm (25 inches) 75cm (28 inches)

Head circ. 42.5cm (15.5 inches) 47cm (17.5 inches)

Development
Gross motor development
By nine months your baby will be sitting alone. If she has only just
learnt to do it she may only manage ten minutes at a time.

While she sits she will lean forwards to pick up toys and examine them.
If she leans sideways she might fall.

She may be crawling very efficiently, starting to crawl or still just


sitting.

She may be starting to pull herself up onto furniture. This gives her a
new view of the world—suddenly she can see what the top of a coffee
table looks like. After standing and holding for a short time she may fall
backwards—bump!

When you hold her she will weight bear and take alternate stepping
movements.

Vision and fine movements


She is visually very eager with a fine eye for detail.

She will start to pick up fluff, crumbs and small objects with three
fingers and may at times have difficulty releasing what’s in her fingers.
Her forefinger constantly leads the way exploring like a little antenna—
poke, poke, poke.

When she drops things she looks for them. By now she is probably
playing the dropping game so you can pick things up for her.

It’s important to provide a safe environment so your baby can explore fully
without too many inhibitions.

Hearing and speech


Your baby is very attentive to voices (especially yours), music and
everyday sounds.

She will turn to a tiny sound behind each ear if she is not too distracted.

She makes talking noises constantly and deliberately, which may be


friendly or surprised or noises which show she is upset or annoyed.

Most babies are now stringing together consonants followed by vowels


like da-da, ma-ma, adaba, agaga and so on.

She will start to imitate noises like a raspberry or a cough.

She understands ‘no, no’ (but doesn’t necessarily obey) and ‘bye-bye’.

Social and play


Fussiness with strangers and distress when separated from their mothers
is common for many babies now in varying degrees.

Your baby can hold finger food well at this age and eat it without too
many mishaps.

Everything still goes into the mouth for a thorough checking.

If asked, she will offer you a toy (if she’s in the mood) but mostly can’t
let go of it into your hand.

She loves playing peek-a-boo and bashing two blocks together. If she
has been taught to she can clap hands, although not necessarily on
request.

When you partially hide something and she is interested and watches
you do it, she will often find it.

Developmental summary: nine


months
Gross motor skills
sits alone for 10–15 minutes;

leans forwards to pick up toys;

attempts to crawl;
pulls to stand.

Vision and fine movements


vision attentive;

stretches out to grab things;

pokes with forefinger;

inferior pincer grasp;

looks in correct direction for falling toys.

Hearing and speech


attentive to voice and everyday sounds;

vocalises (ma, da, ba);

shouts;

babbles;

turns to minimal sound.

Social and play


holds and chews;

distinguishes strangers from familiars;

imitates;

plays ‘boo’;

claps hands (if taught), bangs two blocks together.


Serious developmental delay due to
unknown causes
Growth and Development gives a general guide to developmental delays in
babies that need investigating. A tiny number of babies appear to develop
normally until around nine months, when it starts to become apparent that
possibly things are not quite right. Unfortunately it may be a long time
before a definite cause or prognosis is established. Needless to say it is an
ordeal for parents who face months, even years, of repeated assessments
before knowing what the problem is and what the future holds. Parents,
understandably, sometimes ignore their secret worries, but if you ever have
any concerns it is better to seek advice as soon as possible so you can get
all the help and support available. Health professionals can be over-
reassuring, so if deep down you feel things are not right with your baby,
find someone who is expert at assessing baby/child development. Major
children’s hospitals in capital cities also have child development units
where detailed assessments can be made.

FOR MORE INFORMATION


Chapter 32: Becoming a Toddler (separation anxiety and stranger awareness)
27

Safety
Previous chapter | Contents | Next chapter
The following chart emphasises particular hazards associated with this
developmental stage, but don’t forget most safety hazards remain at any
age and stage.

Don’t forget your baby’s third round of immunisation is due at six


months.
Developmental
Age Safety Hazard Precautions
Stage

Greater manual skills increase the


Remove small, sharp and breakable objects
risk of swallowing or inhaling
from reach
Increasing dexterity foreign objects
7–8
at picking up small
months
objects Be careful of lotions, creams and equipment
Cuts from sharp or breakable objects
on the change table—keep safety pins out of
left within reach
reach

FOR MORE INFORMATION


Chapter 12: Safety (immunisation)
28

Sleeping and Waking—Six Months


and Beyond
Previous chapter | Contents | Part IV
Night waking—your options
First, a refresher about ‘sleeping through’. ‘Sleeping through’ is a
confusing expression as it implies sleeping soundly, without stirring, all
night. In fact humans of all ages have brief waking periods during the
night following a light sleep and dreaming phase before going into a deep
sleep. Babies who disturb their parents at night become fully awake at this
time and are unable to put themselves back to sleep so eventually start to
cry.

At this stage, they are given a breastfeed, dummy, bottle, are rocked and
patted, or are put into bed with their parents. I call these external aids.
There is nothing wrong with using external aids to help babies get back to
sleep as long as parents remain happy to keep obliging. Many babies will
not voluntarily give up their external sleeping aids. As they get older they
continue to rely on certain conditions being in place before they get off to
sleep. Adults also get used to certain conditions like using the same bed
and pillow. If we go on holidays and change our conditions of sleep (the
bed and the pillow) we invariably have trouble sleeping but usually get
used to new conditions of sleep after a few nights—if they remain
consistent—and sleep well again.

Overall, about 40 per cent of babies between six and twelve months
continue to wake at night. The night waking varies between waking once
for a quick feed and going straight back to sleep to waking every two or
three hours.

Many babies start to sleep for longer periods at night without disturbing
their parents by the time they are three months old only to start crying
again at night between six and twelve months. Some research suggests this
is because babies of this age have intense dreaming phases from which
they wake easily.

Babies who still share their parents’ bedrooms are more likely to wake and
want attention more often after six months than babies who are in their
own room, although this is not always the case.

All parents and babies are different and parents have their own individual
expectations and tolerance of night-time waking. Some are quite prepared
for months, even years, of broken sleep, while others hope their babies will
sleep all night without disturbing them by the time they are six months old.
This expectation is not unreasonable, but unfortunately a lot of information
circulating about babies and sleep suggests there is nothing that can be
safely done to change an older baby’s night waking. Consequently, many
sleep-deprived parents live with night waking believing that there is no
other safe option.

Night waking under six months


I believe that not a lot can be done about night waking (once any feeding
or medical problems are sorted out) until babies are over six months of age
for a few different reasons:

Young breastfed babies need to wake and feed frequently in order to


keep breastfeeding working the way it’s supposed to.

Leaving young babies to cry at night instead of feeding them can mean
weeks of crying, which is distressing and unkind for everyone and
rarely changes what the baby is doing.

It often takes six months for parents to get to know their baby, work out
which babycare options they wish to follow, learn the difference
between food, health and behaviour and gain confidence in caring for
their baby.

By six months or so things are different for many


babies and parents
In my opinion between six and twelve months babies are old enough to
learn new conditions of sleep. This opinion is based on my hands-on
work with families over many years. It is also the opinion of many
other practitioners—nurses, paediatricians, psychologists, family
doctors and social workers—whose work involves helping sleep-
deprived parents to better nights with their babies.

Parents who wish to change what’s happening during the night are
more confident about deciding what to do.
It is also much easier at this stage to separate a sleep problem from
hunger or a medical problem. By six months feeding problems are
usually sorted out and the majority of babies are thriving. For most
babies it’s reasonable to assume that they are not waking for hunger,
especially when, as is so common, its a strapping nine-month-old baby
on three hearty meals a day who has never slept more than two or three
hours at a time since birth.

By six months the early months of worrying about ‘colic’, ‘wind’ and
‘reflux’ have faded, so it’s easier now to know if there is actually a
medical problem that’s causing the night waking (rarely is this the
case).

And I know you know it’s not teething:

The tendency to view ongoing sleep problems as teething is misleading


and unhelpful. Babies get twenty teeth sometime between three-and-a-half
months and three years whether they sleep all night or not. Waiting for all
the teeth to come through before doing anything about sleepless nights
means waiting for three years—interestingly, an age some people on the
attachment-parenting end of the sleep spectrum think is about the right
time for parents to expect undisturbed nights, and for parents who are
happy to live with this so be it.

Common causes of night waking apart from sleep


patterns and conditions of sleep
Developmental issues—many things related to normal development
have the potential to interfere with sleep: separation anxiety (see
chapter 32); learning about cause and effect; learning new skills—
sitting up, pulling up on the side of the cot. And as your baby starts to
become a toddler between nine and twelve months you may start to be
aware of the beginnings of the negativity, testing limits behaviour and
even signs of her working out how much control she might have.

It must be emphasised that all these things are part of normal


development and not a sign of ‘naughtiness’ or bad behaviour.

Illnesses (coughs, colds and ear infections are the most common).
A change of environment (different room, different bed, different
house).

A change of routine (holidays, travel, visitors, separation/divorce,


childcare).

Some babies will experience one or more of the above and return to
sleeping all night after the drama is over, but for many the ear infection
gets better, the visitors leave, but the night waking remains.

What’s a parent to do?


Part of deciding to do something about your baby’s sleep pattern is to
work out whether it is a problem or not. Parents often feel pressured by
those around them, so try and learn to ignore uncalled for, unwanted
advice.

Lots of advice about night sleeping only emphasises one option, which
tends to make parents feel bad if they do something different. For example,
‘controlled-crying is harmful and dangerous’ or ‘breastfeeding at night is
wrong’.

There are a few options—the trick is to find what works for you and some
parents go around in circles a few times before working out what they are
prepared to do.

If you are happy or can live with what’s happening, there’s no need to do
anything.

Try to think things through carefully. Changing your baby’s night-time


waking usually involves leaving her to cry (yes, ‘controlled-crying’).
Regardless of how confident or desperate you feel about this, it is painful
for most parents to leave their baby to cry. And undoubtedly temporarily
painful for the babies as well—more on that later.

If your baby is waking once a night for a quick feed and going straight
back to sleep I wouldn’t recommend changing things. If your baby sleeps
for nine or ten hours but doesn’t go off until later in the evening I’d
suggest you live with it for a while. Nor is it useful to leave babies crying
at four o’clock in the morning when they’ve been asleep since seven at
night.

‘Controlled-crying’ is more a strategy for the two to three-hourly night


waker who has not slept all night since birth. I find that teaching-to-sleep
is, in general, a successful way to helping these babies learn to sleep
without calling for help over a short period (three nights).

Most parents ask themselves whether the night waking dilemma could
have been prevented. The answer is probably not, and there is very little
value in soul-searching, agonising and going back over what you did or
didn’t do over the last six months. Caring for babies is not always easy and
everyone does what they have to do, especially during those exciting,
strange and anxious early months.

The four options


Options are limited and despite a multitude of variations on the sleep
theme, when you peel back all the layers there are only four. Changing or
living with your baby’s night-time sleep patterns always involves one of
the following:

1. Teaching your baby to sleep (involves stopping all the external helping-
to-sleep aids and leaving her to cry).

2. Living with it (continue feeding, rocking, patting and bed sharing).

3. Using a sedative (a very limited option and only appropriate in certain


circumstances).

4. The Bhutanese solution.

1. Teaching your baby to sleep


Controlled-crying—otherwise known as ‘teaching-to-sleep’, ‘sleep
training’, ‘control comforting’, ‘comfort settling’, ‘responsive settling’ and
‘progressive waiting’—is the main strategy here. There are many
variations on this theme from leaving the baby to ‘cry-it-out’ after one
visit, to complicated regimes that involve going in every one or two
minutes to plans similar to the one I offer, to combining controlled-crying
with a sedative.

Advantages
It has the potential to bring persistent night-time disturbances by a
healthy baby to an end when all other strategies have failed and the
whole family’s mental health and wellbeing is being threatened.

It has the potential to dramatically improve the relationship of


exhausted parents, and between the parents and the baby.

Solving or at least improving night sleep problems is an aid for post


natal depression.

It is sometimes the only way to stop evening and night-time bottles and
overnight breastfeeding in older babies and toddlers.

Giving parents balanced information about ‘controlled-crying’ helps


them decide themselves whether this is what they want to do. Some
parents need to try it to know they don’t want to do it, which then
makes it easier for them to go back to learning to live with it.

Resuming a sexual relationship as well as re-establishing the emotional


and social relationship that two adults share is easier for some couples
when endless nights of continually disturbed sleep (not just one feed)
and bed-sharing are not getting in the way. Most people can handle this
for a certain period, but there comes a time when couples may want
their babies out of their beds and into separate rooms in the second six
months so they can have some time to themselves. This is perfectly
reasonable. The quality of the parents’ relationship has to be a factor in
the overall consideration of what’s best for baby.

Disadvantages
Leaving a baby to cry until she goes to sleep is painful for baby and
parents. It sometimes causes so much distress that it is abandoned.
Parents may then feel disappointed and let-down, even inadequate in
some way.

It doesn’t always work and good results may not be permanent.


As with co-sleeping, leaving a baby to cry is not safe in certain
circumstances:

If the baby is sick or upset by recent events (moving house, starting


kindy or childcare, a new baby, divorce and separation).

If there are overwhelming emotional, social or economic family


problems. (See chapter 28, When it’s about more than just sleep.)

Leaving babies to cry for weeks on end is unsafe for their physical,
emotional and psychological wellbeing.

Some parents, especially where there is a lot of parental stress, need


help and supervision from a committed, experienced health professional
to do ‘controlled-crying’ safely and effectively.

It has become common for parents to employ ‘baby whisperers’, ‘sleep


experts’ to come to their homes to do what is never called ‘controlled-
crying’ but which, in fact, is a particular version of it. Parents find this
easier emotionally as the responsibility is taken from them and handed
over to someone else. For some parents this is hugely beneficial but
again, satisfactory results can’t be guaranteed and it is expensive. I
think, overall, whenever possible it is better for parents to bite the bullet
and do it themselves, or alternatively try a parent and baby centre if
they have access to one.

Unintended negative consequences in some circumstances may include


changes in the baby’s behaviour such as clinginess and withdrawal. See
later in chapter 28.

There have been no studies done which assess the stress levels of babies
in association with controlled-crying or its emotional or psychological
impact.

The latest Sids and Kids recommendation to reduce the risks of sudden
unexpected death in infancy (SUDI) is for baby to share the room (in a
separate bed) for six to twelve months which may cause parents to be
anxious about having their baby in a separate room after six months.
Teaching babies to sleep on their own is best done with baby in a
separate room as the chance of a successful outcome is minimised when
the baby stays in the same room as the parents. The Sids and Kids
recommendation is frustratingly unclear in relation to the second six
months. It is hard to know if room-sharing in the second six months is
an option or a recommendation. It is also hard to find out exactly
what the risk is of a separate room in the second six months if all the
guidelines for safe sleeping are met. As 95 per cent of sudden
unexpected deaths in infancy have occurred by six to eight months one
has to assume the risk is slight, however if this is of concern to you it
will affect how you handle doing the teaching-to-sleep. If this is the
case I advise you to wait until your baby is twelve months old (or
whatever age you feel comfortable about her sleeping in a separate
room) before you start a sleep training program.

2. Living with it
Sharing your bed is the main strategy here; other commonly suggested
strategies include a three-sided cot adjoining your bed, one parent sleeping
with the baby in her room, a cot lined up beside your bed, going to your
baby and patting her until she goes to sleep, pretending to ignore, minimal
attention, bottles of water instead of milk, free breastfeeding, alternating
‘nights on’ with your partner, re-organising daytime sleeps, sitting in a
chair by her bed until she goes to sleep, a night-light.

Advantages
It avoids having to listen to a baby distressed and crying for any length
of time.

Some parents enjoy sleeping with their babies because of the closeness.
Some of the other strategies mentioned above are not onerous when the
night waking is occasional and when they work quickly to put the baby
off to sleep.

Some health professionals and parents view this option as ‘risk-free’ in


comparison to the various methods of ‘controlled-crying’ which they
believe has the potential to cause harm.

Some health professionals and parents believe co-sleeping and freely


responding to night-time requests from their older babies and toddlers,
regardless of what this might entail, is an important part of creating a
harmonious family life and being a committed parent.

Disadvantages
There are identified risk factors to co-sleeping especially in the first six
months. For babies over six months, the risks can be minimised. See
chapter 11.

Dental decay is a small risk for some toddlers when co-sleeping


includes continuous breastfeeding throughout the night over several
years. Decay is a considerable risk when bottles of milk or juice are
used throughout the toddler years to help get the toddler to sleep in the
first place and back to sleep during the night.

Co-sleeping, endless broken nights feeding and/or patting babies to


sleep, constantly replacing dummies and playing musical beds is not
everybody’s idea of family nirvana. It has the potential to eventually
negatively affect the parental relationship and the emotional life of the
whole family. In my work I find that it is not what the majority of
adults wish to do, which has a lot to do with my approach to routine
sleep problems. There is no evidence, either way, that there are any
long-term advantages for children based solely on where they slept as
babies and toddlers (as long as basic safety measures are in place).

3. Using a sedative
A very limited option and only appropriate under certain circumstances.

Advantages
If it works, a sedative can give everyone a night’s sleep.

It is occasionally helpful for sick babies or babies recovering from jet


lag.

Disadvantages
Sedatives have a relatively high failure rate.

Long-term use of a sedative is dangerous and if overused may have a


negative impact on the baby’s development.

Sedatives do not solve night sleep problems.

4. The Bhutanese solution


In her book, A Baby in a Backpack to Bhutan (Pan Macmillan Australia,
2004), Bunty Avieson and Kathryn, her nine-month-old baby, join a
stream of Bhutanese mothers and babies visiting a local deity for help with
sleepless babies—apparently ‘sleep’ is an issue for Bhutanese mothers too.
In an ancient Bhutan temple, on a high ridge in the Himalayas, a smiling
Buddhist monk lights incense, chants and gently taps Kathryn’s head with
an ancient relic. The results are excellent, Kathryn and Bunty enjoy nine
glorious uninterrupted hours of sleep in separate beds thereafter.

Sound good to me. I wonder if there’s any possibility of arranging for


Bhutanese monks to spend some time in Australian child and family health
centres.

If you are considering making the trip, as well as your baby you need to
take a large quantity of butter, sweet biscuits, top quality incense and
strong beer. Bhutan is a tiny nation nestled in the Himalayas ruled by a
king who has decreed that Gross National Happiness is more important
than Gross National Product. Enjoy your journey.

When it’s about more than just sleep


Sometimes ongoing sleep problems are about more than just sleep. There
are times when baby sleep problems are an indication of more deep-seated
family problems which need to be addressed before dealing with the sleep
problems on a practical level. It is impossible when writing a book to
cover every reader’s individual experience, so, if you are aware of such a
possibility in your household I recommend that you seek professional
advice and help.

A quick rule of thumb is that if you feel that you are continually
distressed about your baby’s night-time waking and you can’t put a
teach-to-sleep plan into action or come to a suitable compromise, then
further help is advisable. Further help involves counselling to resolve
other issues that may be affecting your ability to deal satisfactorily with
the sleep hassles.

Controlled-crying, teaching-to-sleep—proof of
harm/proof of no harm
One of the problems you may be facing is whether strategies to teach
babies to sleep at night by leaving them to cry is harmful. Here is some
information to help you decide. Please peruse the Further Reading list as
well.

Proof of harm
Concerns about harm are based on selective information related to sleep,
childhood development theories, and theories on emotional and
psychological stress in children. Critics of controlled-crying strategies
often use extreme examples of emotional deprivation to support their
claims of harm, for example Romanian orphanages, which bear little
relationship to much-loved babies in good homes in Australia.

The majority of critics are mostly (I acknowledge not always) people who
are not hands-on practitioners and do not have the day-to-day experience
hands-on practitioners have with normal families. They do not have to
come up with suitable, practical ways of helping all families rather than a
relatively few like-minded people.

Proof of harm would have to show that there were long-term, sustained
emotional and psychological problems solely related to doing a safe
version of controlled-crying with older babies and toddlers over a short
period. There are no studies to show this is the case. As a hands-on
practitioner of twenty-five years who helped and followed up around ten
families a week with older baby and toddler sleep problems, I never found
there to be any long-term emotional or psychological ill-effects. In fact for
most of the families the whole issue became a minor blip on the horizon
once the sleep problem was sorted out. Similar anecdotal reports are made
by the majority of hands-on practitioners whose work entails a never-
ending flow of sleep-deprived parents.

Proof of no harm
It is true, however, that despite the fact that versions of controlled-crying
(long before it was called that) have been around for decades there has
never been any assessments done to determine the impact of the stress of it
on babies and toddlers or the impact of it on their emotional and
psychological development. In other words, we do not know for certain
that it is 100 per cent safe.

I acknowledge that because I found ‘no harm’ in my practice does not


mean that there is no risk and that, in some situations, there may be
unintended negative consequences. There may also be unintended negative
consequences when parents feel they are forced to sleep with their baby or
toddler or put up with night-time shenanigans over many years because
there is no safe alternative, not to mention the increased risk of tooth decay
from long-term overnight feeding; breast or bottle.

In the context of a healthy baby in a loving home I believe, based on my


professional experience, that if there were negative consequences due
solely to controlled-crying they would be short-term.

Some babies experience negative consequences from childcare, from


hospitalisation, from giving up their bottles and dummies and from having
their hair washed. To put it bluntly, with help from confident, stable
parents, they get over it.

Children are damaged by war, malnutrition, neglect, emotional


deprivation, abuse, poverty, saturated fats, refugee detention camps,
fighting parents, acrimonious parental separations ... let’s get a bit of
perspective into the issue of ‘sleep’.

Here’s a plan to teach your baby to sleep


As leaving babies to cry is never easy, it’s best to teach your baby to sleep
in the most efficient way possible so it’s all over quickly and everyone can
start enjoying a good night’s sleep. This means planning. The more
haphazard you are, the more exhausting and drawn-out the whole thing
becomes, with little chance of anything changing.

One proviso
As I am not around to give personal guidance I recommend that if you are
following my guidelines for ‘teaching-to-sleep’ and there is any negative
impact on your baby that bothers you or if you do not feel right about it,
please stop. (See later in chapter 28, What if it takes longer than three
nights?).

Before you begin


Your baby must be in a room on her own. This may mean temporarily
moving family members around.

If your baby shares your room and there is no other bedroom, I suggest
you and your partner sleep in the lounge room for a week. Once your
baby is sleeping all night, move back to your bedroom. Unfortunately,
shared accommodation sometimes means a return to disturbed nights.
But if you’re getting desperate for sleep it’s certainly worth a try. If you
are about to move to a bigger apartment or house wait until you move
before teaching your baby to sleep.

If you have an older child in another room and the baby shares your
room, bring the older child into your room for five nights (move the cot
in or put a mattress on the floor). Make sure you tell your older child
this is a temporary arrangement as well as explaining what it’s all
about. Put the baby into the room on her own. Once she’s sleeping all
night, move your older child back in with the baby. I find this works
very well. Often older children sleep better when their baby brothers or
sisters are in the room with them. As well, babies do not wake and call
for room service when they share the room with their siblings the way
they do when they share the room with their parents.

As the aim is to teach your baby to sleep on her own, all external aids
must stop. Remember, swapping one for another will not stop the night
waking—all must be stopped.

Here is a list of all the external aids I can think of: Breastfeeding;
bottles of milk, water or juice; dummies; rocking and patting; walking
the floor; driving around the block in the car; playing games or
watching late-night television; flipping your baby over from front to
back or changing her position; rewrapping. Videos taken of babies who
‘sleep through the night’ show that these babies wake, sit up, talk to
themselves and roll all over the cot, often ending up in some very
strange postures and positions, yet they do not call for attention. Getting
up every few hours at night to change your baby’s position quickly
becomes an external aid. Babies can learn to sleep where they land
without any harmful effects.

You and your partner must co-operate, so talk over your plan of action
well in advance. Teaching your baby to sleep is easier when partners
agree on the course of action and both take part. However, this is not
always possible. In the situation where one is prepared to follow the
plan and the other isn’t, the non-participator must either bury their head
under the pillow or if this is too difficult, sleep somewhere else for
three to five nights. Listening to a baby cry is not easy, but it’s doubly
difficult when one partner undermines the other’s actions.

Let your neighbours know so they don’t give you a hard time. Impress
upon them that you are up with your baby—she is not being left to cry
on her own—and that you would appreciate their patience for a few
nights.

Pick a time that suits you, bearing in mind things like work
commitments, visitors, holidays and moving house. It’s important to
make sure your baby continues to sleep in the same bed, in the same
room for at least a month afterwards.

Your baby must be well (ignore teething).

You and your partner must be well and not under too much other stress
when you decide to teach your baby to sleep. Babies respond well as
long as their parents stay calm and confident—if you become visibly
upset and worried, your baby will get distress signals from you and take
much longer to go to sleep.

The first evening


Here are three key words for you to remember while you are teaching your
baby to sleep. Write them in capital letters and put them on the fridge:
Stay: calm, confident and consistent.

It’s a good idea to start from bedtime so your baby learns how to go to
sleep without breast, dummy and so on. Put her to bed at about 7.30 pm
without any of the external aids. Make sure she has been up since 4 pm at
the latest—a late catnap after 4 pm makes it very difficult for her to go to
sleep before 9 pm or 10 pm.

As she is used to having help to sleep she will cry as you leave the room.
This is the hard part—do not linger, leave. Wait three minutes then go
back in and give brief comfort. Brief comfort means telling her you love
her and a gentle stroke on the cheek. Brief comfort does not include
picking her up, replacing the dummy, a breastfeed, a bottle, rolling her
over or a rock and a pat. If you keep doing these things she will not learn
to sleep on her own. Remember, it is not your job to get her to go back to
sleep any more—it is hers.

After a brief time with your baby leave the room. Do not linger.

Continue to go to your baby but make the intervals longer—wait five, ten,
fifteen, then every twenty minutes until she falls asleep. It may take one or
two hours before she sleeps. Remain calm and confident; she will sleep.

Before going to bed mentally prepare yourself for a stint of night duty.
When your baby wakes next, leave your bed and stay up until she sleeps. It
is much more stressful scrambling in and out of bed than staying up. Make
a cup of tea, perhaps turn on the TV or some calming music. Think of
greener pastures. Repeat the evening procedure.

There is likely to be a fair bit of crying the first night—maybe up to two or


more hours. Each night there is less and by the third night there will only
be a little bit of crying and lots of sleeping. Your baby should be sleeping
well within five nights with a small cry of about ten minutes before she
falls asleep at 7.30 pm. This pre-sleep cry may go on for a few weeks. It’s
best to ignore it. Whatever you do, don’t start any of the external aids
again.

Tips
It is often hard to accept that the dummy must go, but if you continue to
use it the night waking will start up again—the dummy is a problem,
not a solution. I find that once parents make the commitment to follow
the teaching-to-sleep guidelines, throwing the dummy away does not
cause any added disruption, in fact it often turns into a non-event. Put
your baby to bed without the dummy on the first evening you start
teaching-to-sleep and never reintroduce it. The daytime sleeps may not
be great for about a week because the dummy has gone, but once your
baby sleeps all night without the dummy the daytime sleeps will
improve. For more on daytime sleeping after six months see later in
chapter 28.

There is no need to change the nappy—if she slept all night you would
not get up at 2 am to change her nappy.

A good vomit is certainly distressing but remain calm, clean your baby
up with a minimum of fuss and continue from where you left off.
Whatever you do don’t start going back to the old sleeping aids because
of a vomit. Unlike healthy adults, healthy babies and toddlers vomit
very easily and providing they are otherwise well, it is not a sign of
anything drastic. I find babies who throw up when left to cry as part of
teaching-to-sleep stop quickly as long as their parents stay calm and
consistent so the baby gets a clear message.

Once babies are able to pull themselves up they often stand at the side
of the cot and cry until they are ready to fall asleep. If your baby is at
this stage there is no point in lying her down as she will stand up again
before you can blink. Just gently stroke her cheek and leave. It does not
hurt her to stand at the side of the cot until she is ready to lie down and
go to sleep.

There is no advantage in picking your baby up each time you go into


her room—it simply makes it harder for both of you.

What about twins?


It’s a little harder with twins, but the procedure is exactly the same. When
both babies are waking leave them in the same room, plan things carefully
around work schedules and so on and be mentally prepared for a stint of
night duty. You will probably get less sleep than parents with one baby
while you are following the guidelines, but the end results are excellent—
both babies will learn to sleep within the same time frame as one. It’s
much easier when both parents participate so try and arrange a time when
this is possible or if you are a sole parent perhaps your mother or a friend
can help you.

If only one baby is waking it’s better to put her in a room on her own then
move both babies in together again as soon as she’s sleeping.

And premature babies?


You can start any time six months after birth, but if your baby was sick as
a newborn and/or premature please wait until you feel confident and sure
that teaching-to-sleep is what you want to do. When the beginning is
difficult it’s often harder and takes longer for parents to come to terms
with leaving their babies to cry. Thinking it all through carefully and
waiting until you are ready rather than stopping and starting is much less
stressful for you all.

Teaching your baby to sleep may not be an option if:


You think it is wrong to leave babies to cry.

You are uncertain about putting your baby into a separate room.

Your living arrangements involve a shortage of bedrooms, paper-thin


walls or sharing a house with others who may object.

You and your partner cannot come to an agreement over what you
should do.

Some parents would like to change things but cannot bear the thought of
leaving their baby to cry. This is not a sign of weakness and is quite
understandable. It is possible to get help to teach your baby to sleep from
family care centres located in some capital cities throughout Australia.
Services vary from state to state and you may find there is a waiting time.
Commonly asked questions
What if it takes more than three nights?
Sometimes it takes up to seven nights. As long as you are following the
guidelines and the level of the distress is not markedly increasing, keep
going. It should not take longer than five to seven nights. If it does,
perhaps you are not ready for this option yet—you may be combining
teaching-to-sleep with rocking, patting, a dummy and so on.

Or perhaps your baby is not ready. Some babies need to be a little older
(nine to ten months).

Here are some other reasons why it might not be going to plan:

Lack of support from your partner.

A lack of confidence due to disapproval from extended family


members; fear of doing the wrong thing after reading of the dangers of
‘controlled-crying’; or fears that the baby won’t love you any more and
that the ‘attachment is threatened’.

Inadequate planning or it’s the wrong time (sick baby, moving house,
visitors).

Doing it for the wrong reason —‘it’s time I taught her to sleep now
she’s six months old’.

A basic child-rearing philosophy that is at odds with this strategy.

Unknown (it doesn’t always work).

If the teaching-to-sleep is not going to plan it is best to forget about it for


the time being. Consider the above points. Are you able to do something
about any that may be causing you problems? Try leaving it for a month
and start again if you haven’t come to a suitable compromise in the
meantime.

Will my baby be upset and clingy during the day?


Most aren’t, but a few are. The ones who do become clingy are fine after
about a week. Stay calm and consistent throughout—avoid guilty
behaviour that might upset your baby.

My baby seems to be more upset when I go in and out of the


room.
Going in and out of the room is optional. If you prefer not to or want to
make the times in between visits longer, that is up to you.

Will the results last forever?


Unfortunately, maybe not. Illness, holidays, a change in routine and so on
can change babies’ sleep patterns and you might find she starts crying
again during the night. If this does happen, and you know that you don’t
want to go back to regularly getting up at night and/or sharing beds, start
teaching her to sleep again as quickly as possible.

My baby still wakes between 4 am and 5 am. Leaving her to cry


means she cries and cries until it’s time to get up and we’re all
wrecks.
Unfortunately, a number of babies only manage to sleep from around 7 pm
until 4 am after teaching-to-sleep (which is a vast improvement from
waking every two hours) and there usually isn’t an answer to this. Leaving
them to cry in the early hours of the morning for weeks on end is not
recommended. I suggest giving them a quick feed, after which most will
go back to sleep.

Should I put her to bed later so she’ll sleep longer in the


morning?
As a general rule, no. She will almost certainly still wake at the crack of
dawn. Babies sleep very well in the early part of the evening. Putting them
to bed late means they get less sleep and you miss your quiet time in the
evening.

Should I try teaching-to-sleep if my baby sleeps through some


nights and wakes others?
This is a tricky situation. Teaching-to-sleep is really a strategy for the two-
hourly night waker who has never learned to sleep for longer periods
without calling for help. If your baby sleeps through more nights than she
wakes and goes to sleep quickly after minimal attention, carry on with
what you’re doing. If the night waking starts to cause you serious sleep
deprivation, you might like to think about starting teaching-to-sleep. It is
difficult when babies are not consistent because the very night you get
yourself ready for action she will probably sleep all night. By the time the
next bad night comes around you may find you have lost the plot. It’s a
dilemma I have no answer for.

Daytime sleeping—six months and


beyond
The range of daytime sleeping that babies and toddlers do varies from
almost nil to three hours a day and the range of variations in daytime sleep
patterns and habits are similar to those in babies under six months except
that many babies now sleep more predictably.

When babies are not sleeping much day or night it is possible to help them
sleep longer at night by stopping external aids and teaching them to sleep
(see earlier in this chapter). It’s always best to do teaching-to-sleep during
the evening and night and forget about the day because helping them to
sleep better during the night is achievable. Babies always eventually go to
sleep at night—during the day they don’t and may cry for two hours, after
which time a distressed mother picks up a distressed baby and nothing is
achieved. This can go on day after day for an unlimited time. Often when
the nights are better the daytime sleeps improve, but even if they don’t it’s
much easier to manage because at least everyone is sleeping at night.

Unfortunately I have found no sure way to encourage consistent day-time


sleeping in babies who don’t sleep much or who have twenty- to forty-
minute catnaps during the day. It doesn’t hurt a baby not to have much
sleep but there is much more of the day to fill in so the baby has more time
to get bored, cross and over-tired, which in turn makes life more difficult
for the mother who never gets much of a break.
If this is happening to you I think it’s more stressful trying to keep
‘making’ the baby sleep more or longer day after day. It’s probably better
to accept what’s happening, try for three catnaps (make sure the last one
starts no later than 3.30 pm), go out as much as you can, put your baby to
bed by 7 pm and if you haven’t yet done so, follow the teaching-to-sleep
guidelines so you are all sleeping at night.

Babies who sleep more and longer will have one or two hours in the
morning and/or one or two in the afternoon. Daytime sleep times depend a
lot on what time the baby wakes and goes to bed. Some time between nine
and eighteen months lots of babies stay up all morning and have one sleep
of one, two or three hours after lunch.

Early morning waking


Early morning waking is part of the baby package. Not all babies wake at
the crack of dawn but lots do, and most of the time there’s not much you
can do about it. Leaving babies to cry from 5 am onwards doesn’t teach
them to sleep longer and when they have been asleep since 7 or 7.30 pm
it’s not really a fair or reasonable thing to do.

If you have an early morning waker, whatever you do don’t start putting
her to bed later. Babies tend to wake at the same time in the morning
regardless of when they go to bed so keeping her up means she gets less
sleep and you don’t get your time off in the evenings.

Here are the usual strategies to deal with early


morning waking
Get up and start your day. It’s unfair when it’s always the same person
so some sort of roster system should be worked out so both parents get
a chance to sleep in at times. If you’re a single parent there’s not much
you can do unless you’ve got a friend who will step in sometimes.

Bring your baby into bed and give her a breastfeed or a bottle and see if
you can all get some more sleep together.

Give your baby a breastfeed or a bottle or a drink from a cup and put
her back to her bed for another sleep.

Some parents try to slowly extend the time by going in five minutes
later each week.

FOR MORE INFORMATION


Chapter 5: Choosing Baby Products (dummies)

Chapter 10: Early Worries and Queries (vomiting)

Chapter 11: Daily Care (where to sleep—guidelines for co-sleeping)

Chapter 14: Sleeping and Waking in the First Six Months (stages of sleep; ‘sleeping through’;
‘spoiling’)

Chapter 16: For Parents (conflicting advice)

FURTHER READING
The following two books centre on leaving babies/toddlers to their own devices to teach them to
sleep.

Richard Ferber, Solve Your Child’s Sleep Problems, Fireside, USA, 2006. A revised, expanded
(‘sleep’ is taking over everybody’s life) edition of this famous book. Dr Richard Ferber is an
American paediatrician whose speciality area is ‘sleep’—what a hero. His book is based on his
hands-on work at the Children’s Hospital in Boston.

Rosie Cummings, Karen Houghton, Lord Houghton, Le-Ann Williams, Sleep Right, Sleep Tight,
Double Day Australia, 2006. Good info for parents and health professionals based on years of
hands-on experience by the nurses at Tweddle Child and Family Health Service in Melbourne.

The following books promote bedsharing and other strategies to avoid controlled-crying.

1. W Sears, MD, Nighttime Parenting, La Leche League International, Revised edition, 1999.
William Sears is a Californian paediatrician with years of hands-on experience in a wide-
ranging practice.

2. Pinky McKay, Sleeping Like a Baby, Penguin, Australia, 2007.

3. Anni Gethin and Beth Macgregor, Helping Your Baby to Sleep, Finch Publishing, Australia,
2007.

McKay, Gethin and Macgregor’s information is based on their own experiences, selected
research, sleep and child development theories but limited wide-ranging hands-on practice over
many years.

You might like to read the position paper published by the Australian Association for Infant
Mental Health (AAIMHI). The Association does not approve of controlled crying but the position
paper is reasonably balanced without over-the-top scary predictions. Go to www.aaimhi.org.
And for those desperate for a little lightening up on the topic, try Go the F**k to Sleep, Adam
Mansbach and Ricardo Cortés, Akashic Books, New York, 2011.
Part IV:
9–12 Months
Chapters:
29. Feeding Your Baby

30. Growth and Development

31. Safety

32. Becoming a Toddler

{ Return to Table of contents }


29

Feeding Your Baby


Part IV | Contents | Next chapter
Breastfeeding
Late mastitis
Mastitis (see chapter 8) mostly happens in the first three months, but it can
happen any time while you are breastfeeding. Signs and symptoms are the
same as previously described, as is the treatment. A sudden change in
night feeding, a baby who suddenly loses interest in the breast, return to
paid work, ill health or trauma to the breast (perhaps from sport) are all
possible reasons. Sometimes the flu-like symptoms appear first, making
the diagnosis uncertain until the breast symptoms appear. If it doesn’t
settle in six to twelve hours, you will need antibiotics.

Breastfeeding into the second year and beyond


Some women are happy to continue breastfeeding for as long as their baby
or toddler wants to. Night waking is not an issue and, for them, the
rewards of this option outweigh any disadvantages. As well, the thought of
getting their babies/toddlers to sleep by leaving them to cry is
unacceptable.

Unfortunately mothers who do this often get a hard time from all and
sundry and can be made to feel as if they are doing the wrong thing. If this
is your choice, continue to enjoy your baby, your breastfeeding and
sharing your bed for as long as you feel like doing it—some view this
approach as the optimum.

There is, however, the small risk of tooth decay to consider (see chapter 19
).

Weaning older babies


Weaning can happen at any time from soon after birth up to three or four
years of age. It might be your decision or your baby’s or it might be
mutual. All the benefits of breastfeeding are there for as long as you
and your baby wish to continue, so if you are happy with what’s
happening, carry on.

The following information is for women who wish to stop breastfeeding at


night and/or slowly wean between six and twelve months. If your baby is
breastfeeding a lot day and night and you wish to do fewer feeds or wean,
here are some guidelines to follow.

Address the night waking first


Babies who are still breastfeeding frequently during the second six months
usually breastfeed a lot at night and a number of women find they become
increasingly frustrated and depressed because of the constant night
waking.

If this is happening to you, waiting for your baby to decide to feed less or
wean might mean waiting until she is a lot older. It’s fine for you to make
the decision to wean and/or stop night feeding rather than leaving it up to
your baby.

Stopping breastfeeding at night involves teaching your baby to go back to


sleep without the breast. Swapping the breast for a dummy, a bottle, a rock
and a pat and so on is not the answer—it simply teaches your baby to rely
on something else and will probably take even longer to get her back to
sleep. Trying to make older breastfed babies take bottles when they don’t
want to is usually a catastrophe and does not teach them to sleep at night.

Teaching your baby to sleep without the breast involves letting her cry
which is never easy, but by reading chapter 28 and following the
guidelines carefully you can help her sleep all night without the breast
within three to five nights. It takes three to five nights for your breasts to
adjust to not being used at night so don’t forget to hand express for
comfort once or twice a night for three to five nights. If they are really
uncomfortable cold cabbage leaves (see chapter 9) and a firm bra help.

Daytime—diet and fluids


Once your baby sleeps all night without needing the breast to go back to
sleep, only breastfeed her three times during the day with meals. Be firm
and consistent and don’t give her the breast at sleep time. Changing your
daily activities helps until she forgets about the breast.
If your baby takes a bottle you can then replace each daytime breastfeed
with a bottle of formula or milk over the next month or two at a pace
which suits you. If your baby will not take a bottle, forget about bottles;
give her three meals a day and gradually replace each breastfeed with milk
from a cup. Once your baby is not drinking all night and only having a few
breastfeeds during the day you will find she will drink more and more
from the cup.

Some mothers worry about their babies’ fluid intake when they use a cup
instead of a bottle as it seems so much less than the amount babies have
who drink from bottles. Try not to let this bother you—babies who drink
from bottles drink more than they need a lot of the time. When the weather
is hot extra fluids can be given in the form of fruit gels, fruit iceblocks or
by putting extra fluid in the food. Letting your baby sit in the bath and
suck the flannel is another way of giving extra fluid in hot weather.

Once you decide to breastfeed less or wean, be consistent so your baby


gets a clear message. If you do one thing one day and something else the
next she won’t know what’s going on. Never re-introduce a breastfeed
once it’s gone.

Babies who wean themselves


A number of babies take themselves off the breast some time between six
and twelve months. This can be upsetting whether you planned to
breastfeed indefinitely or planned to wean around a year. Unfortunately
it’s usually something you have to accept unless the breast refusal is
temporary because your baby is unwell, in which case she might go back
to the breast when she is better. When it’s permanent, talk about it to
someone sympathetic and have a good cry—the sad feelings will pass.

Again, there is no need to start bottles if your baby is happy to drink from
a cup. Give her small amounts of milk or water frequently throughout the
day. The amount she drinks will gradually increase.

Biting the breast


Mostly, the arrival of teeth makes no difference to breastfeeding, but a few
babies do start to bite which is very painful indeed. Deliberate biting in
older babies (whether it’s a breast or a shoulder) is part of their
development and one way they find out about the world and what their
bodies can do. It is nothing to do with ‘teething’, nor is it intentionally
done to hurt; however, they have to learn that biting another person hurts,
is not a game and it is unacceptable behaviour. Here are a few tips to help
with biting:

Playing with the nipple rather than sucking it for food or comfort is a
diversion for older babies and a time when biting may occur, so try not
to let yourself get distracted while feeding and allow the feed to go past
the time your baby is really interested. Older babies are able to drain the
breast in two or three minutes and may not be interested in extra
sucking time when other things are attracting their attention.

Try not to overreact to a bite (easier said than done, especially when the
first nip takes you by surprise) as a major response from you may mean
your baby refuses all breastfeeds. The minute she bites, a quiet but firm
‘no’ is required. Take her off the breast immediately and don’t
breastfeed again for several hours. Resist offering her your breast every
time she starts to whinge—try diversionary tactics such as a snack, a
drink from a cup or going out.

Like everything to do with babies, try to stay consistent. If you laugh


sometimes, go ‘ouch’ sometimes and keep letting her play with your
breast, the biting is likely to go on indefinitely.

When should a baby feed herself with


a spoon?
Sometimes there is no choice about this because a number of babies won’t
eat unless they can feed themselves. If your baby is an independent eater
and you don’t mind the mess, by all means let her use a spoon and her
fingers to feed herself mushy food as well as the less messy finger foods.

If your baby is happy to let you be in charge of the spoon there is no


urgency about teaching her to do it herself until she is older and has better
co-ordination. Most toddlers can use a spoon reasonably neatly around
eighteen to twenty months.

Bottle feeding
When you are breastfeeding, it is fine to use full-fat cow’s milk in your
baby’s food, on her cereal and to drink from a cup from six months of age.
There is no need to go to the expense of using formula when you are
following this plan. If you are breastfeeding and for some reason don’t
want your baby to have cow’s milk it’s better to use a soy-based infant
formula on cereal, in a cup and so on rather than soy drinks.

When babies are not breastfed or if you wean between six and twelve
months, infant formula is recommended. ‘Follow-on’ formula (labelled
‘suitable for babies over six months’) is an unnecessary product designed
by formula companies to bypass the advertising restrictions placed on
standard formula (labelled ‘suitable from birth’). Follow-on formula has
no advantages for healthy babies who are eating a wide variety of food
unless it is cheaper than standard formula. An unlimited amount of
formula is not part of a well-balanced diet in the second six months when
it’s best to encourage babies to eat a wide variety of family food. Three
bottles of 180–200ml daily is sufficient.

Teach your baby to use a cup and aim to bid the bottles farewell soon after
the first birthday. Prolonged use of bottles in the second year is a risk for
tooth decay, interferes with good eating and is nutritionally unnecessary.
Toddler formula is a marketing ploy aimed at the anxious parents of fussy
eaters (see chapter 32) and as a way to circumnavigate the restrictions on
advertising infant formula. Cow’s milk, and water, ideally from a cup, are
the best drinks during the toddler years and beyond.
FOR MORE INFORMATION
Chapter 24: Feeding Your Baby (particularly information on the use of whole cow’s milk)

Chapter 28: Sleeping and Waking Six Months and Beyond (options for night waking)
30

Growth and Development


Previous chapter | Contents | Next chapter
Growth
Lots of babies are three times their birthweight by twelve months. From
nine to twelve months onwards weight gains are often slow and irregular,
but length continues to increase steadily. The weight of breastfed babies in
particular can level out quite dramatically. As long as they are otherwise
fit and healthy this is rarely a sign of anything being wrong.

AT TWELVE MONTHS
Small/Normal Large/Normal

Weight 8.2kg (18lb) 12kg (26lb)

Boys Height 72cm (28 inches) 80cm (32 inches)

Head circ. 45cm (17 inches) 50cm (20 inches)

Weight 7.8kg (16lb) 11.2kg (25lb)

Girls Height 70cm (27 inches) 79cm (31 inches)

Head circ. 43.5cm (16.5 inches) 49cm (19.5 inches)

Development
Gross motor
By twelve months your baby will be sitting well, on her own,
indefinitely.

She will probably be crawling (some babies still just sit).

Lots of babies are ‘cruising’ (walking around the furniture) by twelve


months.

Many are walking on their own.


If you have stairs, your baby may be able to crawl up the stairs but not
down.

Vision and fine motor


She now uses her index finger and thumb to pick up anything she finds
(crumbs, fluff off the carpet, paper clips and so on).

She can drop objects or release them deliberately (if she wants to). She
can give you a toy willingly (if she’s in the mood).

Both hands are used to play, eat and manipulate objects.

Pointing at everything starts at about a year. It is often not noticed much


because obvious skills like walking and crawling attract much more
attention.

Pointing is a way of communicating found only in humans, and babies


start to point around twelve months, some as early as nine months, but
intentional pointing is never any earlier.

Pointing is a clear communication signal and the way a person singles


out an object as being important enough to consider and contemplate.
By pointing, the person draws someone else’s attention to the object to
get them to consider and contemplate the object as well. Pointing is
always done with someone, not alone. I find pointing a fascinating part
of the development of baby communication skills which happens long
before babies have the verbal skills to draw their parents’ attention to
objects in the astonishing world around them.

Your baby can recognise you from a distance of six metres (twenty
feet) or more.

Hearing and speech


She knows and turns to her name immediately and will also turn to a
quiet noise behind each ear.

Vocalises constantly as if having a conversation using lots of vowels


and consonants; a few babies may have one or two words.

Your baby shows by her behaviour and response that she understands
conversation and simple instructions like ‘Come to Mummy’, ‘Don’t
touch’ and so on.

Social and play


Loves to empty cupboards and tip things out of containers.

Likes having a cuddle, although if you have a ‘busy’ baby, cuddles may
be few and far between at times.

Offers a kiss to people she knows and trusts.

Waves ‘bye-bye’, plays ‘pat-a-cake’ and ‘boo’.

From twelve months on things tend to go into the mouth less often.

Lots of babies start being able to put shapes into the correct hole,
particularly if encouraged and given help.

Your baby will now examine things much more closely before waving
them about and dropping them. She will also start to use things like a
hairbrush or a small broom appropriately.

It’s now quite obvious what mood she’s in—sad, happy, cross and so
on.

Bottom shuffling—a normal variation


Bottom shuffling babies are normal late walkers. Babies who bottom
shuffle move about in a sitting position by extending their legs and then
moving their bodies forwards by pushing with their hands behind them.

Bottom shuffling often runs in families and babies who move around like
this are late to pull themselves up onto furniture as it’s much harder to pull
up onto furniture from a sitting position than a crawling position. This
means they are also later to walk (usually around eighteen months), but
this is no cause for concern.

Non-crawlers—a normal variation


A number of babies bypass crawling. There is no evidence that this causes
problems and opinions vary as to whether some sort of intervention makes
any long-term difference. Like many areas in babycare, the decision
whether or not to give your baby therapy is ultimately yours. Ask a few
different people for their opinion before becoming committed to time-
consuming exercises and activities for your baby which will make you feel
guilty when you don’t do them.

Developmental summary: twelve


months
Gross motor
sits well, indefinitely;

crawls;

cruises, walks.

Vision and fine motor


pincer grasp;

watches toys fall to the ground;

points with index finger;

recognises familiar people from six metres away (twenty feet).


Hearing and speech
knows own name;

vocalises—vowels and consonants;

understands the meaning of many concepts and words as well as simple


instructions.

Social and play


may drink from a cup;

holds a spoon;

helps with dressing if in the mood;

tips things out of containers;

likes having a cuddle;

demonstrates affection;

plays ‘pat-a-cake’;

waves ‘bye-bye’.

FOR MORE INFORMATION


Chapter 32: Becoming a Toddler (toys and activities)
31

Safety
Previous chapter | Contents | Next chapter
Holiday safety
It’s essential to be aware of the added hazards to your child’s safety when
the family leaves home for a while.

Holidays with babies are different from holidays on your own. Parents
often feel there’s no such thing as a holiday with babies and toddlers; it’s
simply a change of scenery with fewer conveniences and more work.
Despite this, everyone still does it. Parents enjoy the change of scenery and
the opportunity to spend time with their babies without having to worry
about the demands of life in the suburbs and the routine of the working
week for a while.

The hard work of holidays does centre around keeping little ones safe.
Constant vigilance is essential.

Going to live in an unfamiliar environment is the first hazard. Whether you


are renting a flat or house or camping, check the surrounding areas to
make sure they are safe for playing. Ask about potential drowning hazards
such as pools, spas, ponds, septic tanks or post holes. Find out the
whereabouts of any barbecues or incinerators. Make a note of driveways
and which way cars come and go (especially in camp sites) so your baby
or toddler plays in a safe spot.

A rented house or a flat is unlikely to have any of the safety features


around that you have in your home, so pack some of the equipment you
use at home to make the surroundings safer.

Appliances such as the stove, the hot water system, the kettle, the toaster
or the washing machine may not be as safe or in as safe a place as they are
at home. Also, check baby furniture such as the cot if it is supplied with
the house. Watch out for flimsy curtains near the stove or for venetian
blind cords that may hang over the cot. Old-style holiday cottages often
have strange containers of liquid in outside toilets or laundries that need
putting out of reach.

Access to windows may be easier, which increases the risk of a toddler


falling out. Look in the bedroom your baby is going to occupy and remove
any mirrors, heaters or fans which might be broken or played with.

Camping holidays
These need to be planned very carefully. Camping usually means a
confined cooking, sleeping and living area. The combination of this and
active young babies can lead to tensions, especially in wet weather, which
makes accidents more likely to happen.

Keep cooking, sleeping and lighting equipment simple and safe. If you are
in a tent it is much safer to have equipment without a flame. When
sleeping bags are dry-cleaned you should allow at least a week before they
are used. After dry-cleaning they need to be aired for four to five days.
Children have died in un-aired sleeping bags due to breathing fumes from
the dry-cleaning chemicals.

If you are staying with friends or grandparents who normally do not have
babies or children around, there are likely to be many hazards within easy
reach of curious minds and fingers, not to mention potential damage to
prized possessions in your host’s home.

Check where medicines are kept and poisons are stored. I remember
leaving my son to sleep on his grandparents’ bed only to find when we
went to get him up that he had emptied out every drawer and cupboard in
the bedroom and liberally applied every bit of make-up he could find to
himself and the cream wool carpet. Luckily there were no medications in
their bedroom.

Water plays a big part in summer holiday fun. Unfortunately drownings


keep happening. Remember small children fall into water with so little
sound it cannot be heard above normal conversation. There is no such
thing as a ‘drown-proof’ child, even those who have been to swimming
lessons.

General guidelines to follow for water safety


Never leave your baby alone in water such as the bath or a wading pool
while answering the phone or door. Take her with you when you go if
there is no other adult around to supervise her in the bath or pool.
Don’t leave younger children in the care of older children at bath time
or when they are playing at the beach, near a creek or near a river.

Flotation toys and swimming aids are not lifesaving devices and do not
replace adult supervision.

Alcohol increases water hazards. During the holiday season there is


likely to be more risk of being in situations where there is both water
and alcohol. If you are taking your baby to a pool party, decide
beforehand which parent is going to drink and which parent is going to
drive and take care of their baby in a hazardous environment.

Remember to drain wading pools after use and remove the access
ladder from above-ground pools when swimming is over for the day.

See chapter 19 for more on water safety.

The following chart emphasises particular hazards associated with this


developmental stage but don’t forget most safety hazards remain at any
age and stage.

Don’t forget your baby’s immunisation which is due at twelve months.


Developmental
Age Safety Hazard Precautions
Stage

Turn handles away from edge of


Scalds—pulls protruding handles on the stove or bench.
stove
Fit a stove guard.

Non-flammable clothing such as


Burns—clothing catches alight (open fires wool or treated fabrics.
and barbecues)
Fitted nightwear.

watching Always supervise near water.

learning Do not leave older child in


charge.
imitating Drowning—in bath, buckets of water, fish
pond, wading pool, swimming pool Cover fish ponds, empty bath,
absorbing buckets, wading pools when not
in use.
12–18 exploring
months Safe storage of nappy buckets.
finding out
mastering gross Keep poisonous materials locked
motor and fine away in high cupboards.
motor skills
Poisoning—medication, confuses tablets with Don’t take medication in view of
very mobile sweets, drinks fluids from bottles (especially small children.
soft drink bottles)
Store poison in correct containers
(not cordial or soft drink bottles).

Keep tools and knives out of


Cuts—from knives and sharp utensils
reach.

Remove doors from old fridges


Suffocation—airtight spaces such as old
and lock wardrobes—put key
fridges, wardrobes
somewhere out of reach.

FOR MORE INFORMATION


Chapter 12: Safety (immunisation)

Chapter 19: Common Worries and Queries (swimming)

Chapter 22: For Parents (travelling with your baby)


32

Becoming a Toddler
Previous chapter | Contents | Recipes
The toddler age is from about twelve months, when toddling starts, to three
years. It is a time of tremendous development when babies discover they
are able to use their minds and bodies to do things and make things
happen.

Learning to do things and make things happen can be quite frustrating for
the toddler as well as for her parents. Children of this age have a strong
desire to be independent but still need a great deal of help and security. As
they learn to do things more efficiently and to understand the world around
them more, they experience less frustration and lots of the exasperating
things they do fade away. So it’s important to realise that the things your
older baby or toddler does to assert herself and her attempts at
independence are by no means indicative of her future temperament or
character. Toddlers do many things that adults find exasperating and some
toddlers do them more than others.

Temper tantrums, not eating, not sleeping, biting, thumping other toddlers,
not wanting to poo in the pot and whingeing are some of them, to name
just a few. All of this sounds very negative—a lot of the time, of course,
toddlers are rewarding, funny and enchanting and parents find they are
well compensated for the exasperating times by the enormous amount of
pleasure they get watching and helping their baby through this stage.

Some babies don’t get into the full swing of toddlerhood until they are
fifteen months old; others start to change from the easy, cuddly baby stage
as early as nine months. When your nine-month-old suddenly refuses to
eat lunch or launches into a mini temper tantrum by flinging herself
backwards when something upsets her, it marks the beginning of a new era
for you both.
Here are some of the things you might find your baby starts to do any time
from nine months onwards. They are all normal and the suggestions to
help are aimed at managing your life together and not making things
worse, rather than providing solutions as in time they disappear.

Difficulty dressing, undressing and


changing nappies
And very frustrating this is! Suddenly you find your baby does not lie
peacefully while you attend to her daily care and it all becomes a
monumental struggle. Changing a pooey nappy is a major catastrophe
which is particularly trying if your baby poos four or five times a day, not
to mention if you are on holiday somewhere in the back blocks with no
decent changing facilities. Your baby’s resistance to dressing and nappy
changing may last well into the second year.

What can you do? Not a lot, unfortunately. Distract your baby as much as
possible with toys and music and obviously have everything at the ready to
do the job as fast as you can. Holding and distracting a determined baby is
much easier with two than one so always get help if help is around.

Not eating
Faddy appetites in healthy babies and toddlers aged between nine months
and three years are quite normal and often start to happen between nine
and twelve months. Some babies of this age have never eaten happily from
a spoon so refusing food is not a new event. Others who used to eat with
gusto suddenly start refusing all their lovingly prepared nutritious meals,
particularly vegies.

What can you do? Remember your job is to offer your baby food, not force
her to eat it. This means a change in your behaviour and may take a little
while to come to terms with. Leaving the job to your baby will probably
give you a feeling of neglecting her, but babies understand from a very
early age that the decision to eat is theirs and they will exercise this choice
in a very human way. When healthy babies are in a loving environment
and are being offered the right food it is unusual for them to have negative
effects from picky eating.

There are several reasons why toddlers lose interest in food and why their
bodies still function efficiently even when they appear to eat very little:

After the first year their growth rate slows down, they do not need as
much food and they are not as hungry.

Most have accumulated stores of fat and other nutrients which stand
them in good stead.

Their bodies use what they do eat very efficiently.

Food becomes relatively unimportant for many toddlers compared to


other things in their lives.

As so many older babies and toddlers have little interest in food yet remain
active and healthy it is reasonable to assume this is a normal state of affairs
for the human body at this time.

Here are a few tips


A lot of babies will not eat unless they can feed themselves with their
fingers. There’s no doubt it’s not nearly as rewarding to have finger
food thrown around the room as to have a nice plate of pureed vegies
disappear neatly into an open mouth, but if this is your baby’s choice
save yourself a lot of angst and accept it.

Resist the temptation to keep replacing meals with extra bottles of milk
and juice. This only fills your baby up and makes her less inclined to
eat. Three bottles of milk a day is more than enough for babies aged
between nine and twelve months. If you are breastfeeding do what suits
you and your baby. Three breastfeeds a day are plenty for babies in this
age group; if you want to breastfeed more frequently, that’s fine, but if
your baby is having a lot of breastfeeds she may not eat much.

Give breast or bottle after the food and avoid any drinks an hour before
the meal if you can.
Nourishing snacks throughout the day are quite acceptable. Make sure
they are nutritious, not chocolate custard, biscuits and sticky fruit bars.
But if your baby snacks a lot don’t expect her to eat three formal meals
a day as well.

If your baby is or has become a fussy eater, try not to let it turn into a
major issue. Avoid cooking and preparing a million nourishing meals
which do not get eaten. Your efforts will be unappreciated, you will
become angry and upset—and probably overweight when you keep
polishing off what your baby doesn’t eat. Keep the food simple, stay
calm and pretend you don’t care whether she eats or not. As faddy food
behaviour frequently lasts (on and off) up to three years of age, constant
confrontation and stress about eating can unnecessarily turn these years
into a nightmare.

Separation anxiety and stranger


awareness
Part of a growing baby’s mental development is all about learning how to
tell the difference between things, places and people and how to compare
and judge them. Separation anxiety and stranger awareness refers to the
time in a baby’s life when she realises the difference between her mother
and a few other close acquaintances and the rest of the world. When this
happens lots of babies start to make a fuss when unfamiliar people look
after them or even just pay them attention. Glasses and beards put some
babies off, others shriek whenever a particular person comes near them
(which is unfortunate when it’s a grandparent). They also become
distressed if they are taken to unfamiliar surroundings even when their
mother is with them.

Stranger awareness and separation anxiety happens any time from three to
four months to nine to twelve months. It is most common and intense
around nine months. Not all babies show signs of being upset while they
are learning to tell the difference between faces and places and it’s difficult
to come up with reasons why some do and some don’t. Lots of exposure to
new faces and places from a young age doesn’t necessarily make any
difference. In the same family where the environment is similar for all the
children, one baby may be incredibly clingy and another won’t.

Becoming clingy, anti-social with unknown people and distressed in


strange places is normal for many healthy babies at this time and to a large
extent outside your control. If your baby is like this it does not mean she is
spoilt or insecure. On the other hand if she mostly doesn’t give a hoot who
she is with or where she is it doesn’t mean she is not attached or hasn’t
bonded. The normal range of separation anxiety varies tremendously.
Some babies pass through it quickly. Others are unsure about being away
from their mothers or meeting strangers until the age of two or even older.

Separation anxiety often puts women in a turmoil when they are trying to
work out aspects of their lives—especially in relation to paid work,
occasional care (for much needed time off) and solving night-time sleep
problems, particularly when older babies are still being breastfed
frequently through the night.

Remember, if your baby is clingy and gets distressed at being somewhere


strange, it is normal. In a good, loving environment it will not harm her to
start learning to separate for short periods such as:

Occasions when you want/need some time off to go to the dentist,


shopping, classes or part-time paid work.

When it is essential for your sanity (moving your baby to her own room
and teaching her to sleep) or leaving her somewhere safe while you
attend to household chores or to your own personal requirements
(showering, dressing or going to the toilet).

Some guidelines to help with separation anxiety


Make whatever arrangements you need to and stick to them, including
having a shower and going to the toilet alone. It doesn’t matter if your
baby performs for thirty minutes as long as she is left in a safe spot.

Tips for regular childcare


A sensible babysitter and quality childcare is crucial. The carer needs to
be someone who is very patient, understands the baby’s distress is
normal and temporary and is willing to mind her without giving you a
blow-by-blow description of the drama when you return.

Babies will usually settle with a carer in occasional care after about
seven weeks. If they are not happy within seven or eight weeks chances
are they are going to continue to be unhappy indefinitely. If the hours in
care per week are short and you desperately need a break, it’s difficult
to see that it will cause any long-term harm as long as your carer is
willing to continue. Long daycare is another matter (see below).

Spending time with her at the centre or the carer’s until she becomes
familiar with the place and the people helps.

Try not to leave your baby at her carer’s in a great disorganised flurry.
Make sure she has her security items (lambskin, dummy, blanket,
cuddly or special toy).

When you are leaving her, leave decisively. Don’t stop and start and
hang about. Remember, lots of babies and toddlers cry initially, are fine
for the period you are not there then cry again as soon as they see their
mother.

Resist the temptation to sneak off to avoid the fuss that occurs when she
knows you are going. Overall this will only make her more anxious.
Painful as it may seem it is better for her to learn to trust you and know
that when you go, you will always come back.

Long daycare for paid work purposes (long day


centres or family daycare)
A small number of babies never settle. If this happens you do have to look
at things again. You may decide an unhappy baby outweighs the benefits
of paid work. If possible other options have to be looked at which may
include arranging one-to-one care at home with a nanny (obviously not an
option for many families), a relative, your partner or giving up the paid
work temporarily.
Feet and shoes
Many babies start walking between nine and twelve months and their feet
often go in all directions when they first start to walk. This is quite normal
and rarely needs any special treatment or equipment. Feet turning in, feet
turning out, bow legs and flat feet are all common variations of normal
posture that worry parents. Another interesting one is the baby who bends
her outer ankle so the edge of one foot rolls over.

All these things are seen frequently in many babies from the time they start
to walk (nine to nineteen months) until the time their legs straighten and
their feet point ahead (between two and five years). Plasters, night splints,
inserts and special shoes are generally not needed, but if in doubt ask a
specialist such as a paediatric physiotherapist or a paediatric orthopaedic
surgeon.

Shoes
Babies need shoes for warmth and protection, not for development. They
learn to walk and run more efficiently in bare feet so leave your baby
barefoot whenever it’s warm enough and she is not in danger of hurting
her feet.

Wait seven to eight weeks after she starts walking before buying shoes.
Until then let her stay barefoot or use socks. Slipping and sliding can be a
hazard—bootees with a non-slip sole are available for older babies.

The first shoes need not be expensive. Bear in mind that they don’t last
long.

The fit should be the same size and shape as the foot with sufficient
room for the toes.

Rounded toes are preferable but sandals with a firm heel are fine for the
summer.

Shoes should be flexible, not too heavy and have a firm heel. Ankle
support is not required. The only advantage to expensive leather ankle
boots is that they are more difficult for your baby to keep removing.
Sneakers, preferably with a firm heel and ventilation holes, are fine.

Toys and activities


This is a watching, learning, imitating, absorbing, exploring and finding
out stage as well as being a time when your baby is mastering her gross
motor and fine motor skills.

A few suggestions for toys and activities


Continue books—babies love books.

Short bursts of screen-time watching shows such as ‘The Wiggles’ and


‘Playschool’ are fun for her but resist the temptation to use the TV as a
babysitter.

Toys that give her practice with her hands are things like: nesting cups;
peg boards with pegs and string; pull-along-string toys (for practising
her pincer grasp); blocks (for building up, knocking down and banging
together); a collection of things in a container that can be taken out,
examined and put back; babies love keys—organise a safe set for her;
they also love old telephones.

Bath toys; once she sits alone in the bath, tipping and pouring bath toys
will interest and delight her.

Toys that help her to practise gross motor skills are things like a
weighted trolley she can push around when she is at the cruising stage.
Balls are always popular. A big cardboard box she can crawl in and out
of is lots of fun—make sure there are no sharp edges or staples.

She will enjoy an obstacle course made of cushions, blankets and


boxes.

Music is important; babies are musical and enjoy any music from birth.
Your baby will quickly pick up simple nursery rhymes and repetitive
tunes.
Household items. Babies often prefer things in cupboards to things in
their toy boxes, such as: a torch; cardboard egg containers; old
magazines and junk mail; pots and pans with lids; measuring cups and
spoons; band-aids; wooden spoons; safe cutlery; cardboard tubes (toilet
rolls, foil and plastic wrap rolls); playing cards; funnels, strainers and a
colander; a pastry brush.

Don’t forget to check everything for safety.

Playgroups
The Playgroup Association of Australia is a voluntary organisation whose
main aim is to provide regular, informal groups of babies, children and
parents in local areas so the children and parents can learn through play
and get to know each other.

The association also publishes written material for parents, runs


conferences and is a wonderful resource for information about children’s
development, their educational and emotional needs as well as things to do
and places to go. Joining a playgroup is a good way to get to know other
parents and if you are lonely you can join at any time, even when your
baby is quite young. If you don’t feel the need to seek company but would
like your older baby to mix with other babies and toddlers, wait until she’s
about fifteen months.

Playgroups don’t suit everyone and it’s important that you enjoy it as well
as your baby. There are usually a few different groups in any area so it’s
worth looking for one that suits you. If you decide a playgroup is not your
style, that’s fine. While it’s a great resource it’s by no means essential for
your baby’s optimum growth and development.

FOR MORE INFORMATION


Chapter 19: Common Worries and Queries (care of teeth; recycled food in the poo)

Chapter 25: Common Worries and Queries (‘spoiling’ and discipline)

FURTHER READING
The Mighty Toddler, Robin Barker, Xoum, 2014.

The Emotional Life of the Toddler, Alicia F. Lieberman, Simon & Schuster, 1995.
Recipes
Previous section | Contents | Next section

We live in a wonderful country with a fantastic variety of foods available.


Use them, experiment with them and mix them so that your baby learns to
enjoy the delicious flavours and textures of good food. The following
section is a list of possible meal suggestions for your baby. This list is by
no means exhaustive, and is only meant to serve as a guide to the kinds of
food your baby should be eating when you begin weaning.

4–6 Months

6–9 Months

9 Months and over


4–6 Months
For all the following first foods add breastmilk, formula or boiled water to
get to the consistency that you want. Start with one or two teaspoons of
food and gradually increase the amount to one or two tablespoons at a pace
to suit your baby. Freeze the remaining amounts in icecube trays.

You can use a fork, food processor, blender or mouli to puree the food.
Rice cereal
For commercial rice cereal just follow the directions on the packet. Home-
made rice cereal is amazingly easy and tastes delicious—parents may want
to eat it too!

¼ cup rice powder (Made by grinding raw rice in a food processor or


blender, do it on a high speed for a few minutes. Do two cups of rice
and store the rest in a sealed jar in the fridge.)

1 cup of made-up formula

Mix rice powder and milk together in a small saucepan. Bring mixture to
the boil whilst stirring. Continue to stir and cook gently for about four
minutes or until creamy. If it is too thick, add more formula and mix
through. Take out the amount that you require and refrigerate the rest.
Reheat with a little formula if it needs to be thinned down.
Banana
1 ripe banana

Mash banana with a fork until smooth.


Apple
2 medium apples (try the many different varieties available)

Wash, peel, core and slice apples. Put in a microwave dish with 1
tablespoon of water. Cover and cook on high for 5–7 minutes. Remove and
mash with a fork or other appropriate equipment.

OR

Put apples in a saucepan with ¼ cup of water and cover and cook on a low
heat until soft. Mash with a fork or other appropriate equipment.
Pear
2 ripe pears

Wash, peel, core and slice pears. Put in a microwave dish with 1
tablespoon of water. Cover and cook on high for 5–7 minutes. Remove and
mash with a fork or other appropriate equipment.

OR

Put pears in a saucepan with ¼ cup of water and cover and cook on a low
heat until soft. Mash with a fork or other appropriate equipment.
Potato
2 potatoes

Wash, peel and cut the potatoes in pieces. Microwave, steam or boil until
soft. Mash with a fork or other appropriate equipment.
Sweet potato
1 small red or white sweet potato

Wash, peel and cut the sweet potato in pieces. Microwave, steam or boil
until soft. Mash with a fork or other appropriate equipment.
Pumpkin
300–400g of any variety of pumpkin

Wash, peel and cut the pumpkin in pieces. Microwave, steam or boil until
soft. Mash with a fork or other appropriate equipment.
Carrot
1 carrot

Wash, peel and cut the carrot in pieces. Microwave, steam or boil until
soft. Mash with a fork or other appropriate equipment.
Avocado
½ a ripe avocado (you eat the other half mashed with garlic and lemon
juice or just splash in some balsamic vinegar)

Mash avocado with a fork.


Yoghurt
Plain, full-fat yoghurt

Yoghurt is very versatile. You can mix it in with any of the above foods
for new flavours.
Peaches
1 ripe peach

Peel, remove stone and slice or cut the peach. Microwave, steam or boil
until soft. Mash with a fork or other appropriate equipment.
6–9 Months
Now it gets more interesting as you can begin to mix foods together. Add
yoghurt to fruit, and grated cheese to vegetables, and you suddenly have
several new meals for your baby to try.

Try different vegetables individually and mixed together in all sorts of


combinations. Buy vegetables in season so that they are at their tastiest and
cheapest. This is the time to try a range of vegetables such as celeriac,
beetroot, taro, artichoke, Jerusalem artichoke, bok choy and choy sum.
Your greengrocer should be a wealth of information as to when vegetables
are available.

Grains can now be introduced, such as pasta, rice, cous cous and bread,
and these can be served individually or mixed with other food. Use fresh
or dried breadcrumbs to add variety.

Lean beef, lamb, pork, chicken and fish can be introduced now, along with
egg yolks.

Use a variety of cheese to add different flavours to dishes e.g. edam,


cottage, gruyère, cheddar, mozzarella, gouda, haloumi, fetta and Swiss.
Vegetables
Peel and chop vegetables. Steam, boil or microwave until soft. Mash
roughly with a fork or use a food processor or blender if appropriate.
Suggestions for vegetables
Vegetables in the six months section as well as the following: beans;
beetroot; broccoli; capsicum (red, green, yellow); cauliflower; celeriac;
choko; eggplant; fennel; green leafy vegetables like spinach; Chinese
vegetables; leeks; parsnip; peas; squash; taro; tomato (peeled and de-
seeded); turnip and zucchini.
Serving suggestions
Serve each vegetable individually or use your imagination to mix any
combinations together.

Mix two vegetables together, e.g. pumpkin and potato, capsicum and
sweet potato.

Add grated cheese to cooked hot vegetables and stir through.

Add cottage cheese to vegetables and mix.

Mix cooked rice with any vegetables.

Mix cooked pasta (use different shapes) with any vegetables.

Mix any vegetable with cooked red lentils. (See recipe for Lentil and
meat hotpot for how to cook lentils.)

Mix through some hard-boiled egg yolk with any vegetable.

Mix cooked lean beef mince or chicken mince with any vegetables.

Mix cooked lean mince with rice or pasta.

Mix tinned fish such as tuna or salmon (remove bones) through any
vegetable.

Mix cooked, flaked fresh fish (remove all bones) through vegetables.

Mix any vegetable with cous cous.

Mix vegetables with cooked or tinned mashed legumes, e.g. three-bean


mix, baked beans.

Experiment with different flavours. Moisten food with tomato paste, tahini
(sesame seed paste), hommus (chick pea paste), lemon juice, white sauce,
cheese sauce or soy sauce. Small amounts of finely chopped fresh herbs
like parsley, basil, coriander, dill, chives or spices such as nutmeg, paprika
and ginger can be mixed through dishes to vary the taste.
Cous cous
Pour 1 cup of boiling water onto 1 cup of cous cous. Stir and then leave for
a few minutes and then fluff up with a fork. That’s it. Use stock instead of
water for a change.
To cook meat
It’s easy. Puree a leftover casserole (cheaper cuts of meat can be used for a
casserole such as blade, chuck, gravy beef or round steak). Puree or mince
leftover roast beef (use the inside bit as it is more moist). Blend grilled or
pan-fried meat—use suitable cuts like fillet steak, rump steak, sirloin
steak, veal, trim lamb, lamb loin chop or lamb cutlet. Don’t overcook the
meat. Puree meat with gravy, stock, vegetable water, water or milk.
To cook chicken
1 chicken breast fillet (about 250g), remove skin

ON THE STOVE: Put chicken fillet in a saucepan and cover with water.
Bring to boil. Reduce to low heat, cover and simmer for about ten minutes
or until chicken is cooked. Remove chicken.

TO MICROWAVE: Place chicken in a suitable microwave dish and


pierce chicken a couple of times. Toss in 1 tablespoon of lemon juice to
coat chicken breast. Cover and cook on medium-high for 3 to 3½ minutes.
Stand for a few minutes.

Mince in a food processor or blender or cut very finely and add water,
vegetable water, stock or white sauce to make it moist.
To cook fish
1 fillet of fish (about 150g)

lemon juice

½ teaspoon butter

TO MICROWAVE: Put fish in a suitable microwave dish. Add a few


drops of lemon juice and dot with butter. Cover and cook on high for about
three minutes or until the fish is soft and can be flaked easily.

TO BAKE: Place a piece of fish on a sheet of foil. Add a few drops of


lemon juice and dot with butter. Wrap the fish in the foil and then cook for
about ten minutes on 180°C.
White sauce
2 tablespoons butter

2 tablespoons plain flour

300ml full-cream milk

Melt butter in a small saucepan. Remove from heat. Stir in flour and then
cook over a low heat for one minute. Gradually add milk, stirring
constantly over a medium heat until boiling. Simmer for two minutes.
Makes one cup of sauce.
Cheese sauce
1 quantity of white sauce

½ cup cheese, grated

After making the white sauce, remove saucepan from heat and mix
through the grated cheese.

Mix the sauce through cooked minced chicken or flaked salmon or tuna
and cooked pasta.

Mix the sauce through some mashed vegetables.


Lentil and meat hotpot
200g red lentils (about 1 cup)

4 cups water

1 tablespoon olive oil

½ onion, chopped

100g lean beef mince

1 tablespoon tomato paste

½ cup water

Boil four cups of water and add lentils. Simmer for about thirty minutes or
until soft and then drain. (When cooking lentils for another use, try
cooking in stock and a bay leaf. Remove bay leaf after cooking.)

Heat oil. Add onion and cook until soft. Add meat and stir to break up
lumps and then cook for ten minutes stirring occasionally. Mix through
tomato paste. Add lentils and water, boil and then cover and simmer for
ten more minutes, stirring occasionally.

Makes about 2½ cups. Serve on its own or with cous cous or rice. Suitable
to freeze. Cook double this amount of lentils and freeze half of them for
another use.
Fruit
It’s time for your baby to enjoy a wide selection of ripe fruit, served
separately or mixed up in all sorts of combinations. Fruits may have to be
peeled, cooked and mashed depending on the fruit. Some fruits can be
grated, e.g. apples and pears.

Fruits that are inherently soft like bananas and mangoes do not need to be
cooked first. Fruit should be ripe. Please take care with seeds and pips.

Fruits to try: Those in the 6 months section as well as the following:


apricots; grapefruit; honeydew melon; kiwi fruit; lychee; mandarin; nashi
pears; nectarines; oranges; pawpaw; pineapple; plums; rhubarb;
rockmelon; sugar bananas and watermelon.

To serve fruit and add variety


Mix through some plain, full-fat yoghurt.

Top some cooked fruit like apple, peach or pear with a mixture of baby
muesli and butter and bake for a delicious crumble.

Toss different fruits together, e.g. apple and peach or banana and grated
apple.
Fruit gel
1 cup juice (fresh or use a commercial juice that is labelled with no
added sugar)

2 teaspoons gelatine

Heat half of the juice and gradually stir in the gelatine to this hot juice.
Add the rest of the juice and stir. Refrigerate until set.
Finger foods
Around 9–12 months you can start to offer your baby finger foods.

Offer
Steamed or microwaved vegetables cut into the shape of chips, e.g.
carrots, swede, zucchini and green beans.

Cubes or slices of cheese.

Grated cheese mixed with grated vegetables, e.g. cheese and carrot.

Pieces of suitably prepared fruit, e.g. sliced mango, sliced ripe peach or
apricot, tinned apricots, pears or peaches.

Slices of cooked tender meat or pieces of cooked chicken. (Dip into


yoghurt, mayonnaise, tahini or hommus to make it moist.)

Cruskets.

Cooked pasta.
Polenta fingers
1 cup milk

¼ teaspoon vanilla essence

⅓ cup polenta

Heat milk with vanilla until nearly boiled. Slowly add the polenta whilst
stirring. Turn down heat and cook and stir for five minutes. When it is the
consistency of mashed potato, spoon the mixture into a small, greased
baking tin, sprinkle with cinnamon and refrigerate until cold. Cut into
fingers.
Rusks
Make rusks yourself as they are easy to prepare and much cheaper than
commercial rusks. Cut day-old bread into four pieces. Put in microwave
uncovered for one minute on high. Leave for five minutes to harden or
bake in a 150°C oven for about one hour. For a change, smear a little
Vegemite on the bread before cooking.
9 Months and over
Now we are talking real food here. Look for recipes that the whole family
can enjoy that are suitable for baby as well. This need not be difficult. Try
risottos, pasta and sauce, gnocchi (plain, add sauce or mix with grated
cheese), frittatas, rissoles, meat or fish or lentil loafs and meat balls. Many
family recipes are suitable for a baby. Be adventurous. When in doubt
babies usually love pasta; just add grated cheese or bolognaise sauce.

• Avoid hard foods such as nuts, whole apple, carrot.

The serving size of the recipes are for two adults and one or two small
children unless otherwise stated, and recipes use standard cup and spoon
sizes.
Basic tomato sauce
1 tablespoon olive oil

1 small crushed clove of garlic

1 × 400g can tomatoes (or nearest size)

a few fresh basil leaves, chopped or shredded

¼ teaspoon sugar

pepper

pinch salt

Heat oil in a big frying pan. Add garlic and stir for a few minutes but do
not brown it. Add tomatoes with the juice and crush tomatoes with a spoon
in the pan. Add sugar, pepper, salt and basil. Cover and simmer for about
fifteen to twenty minutes.

N.B.: Double the mixture to serve four, or freeze half of it for another
meal.

Variations: This tomato sauce can be used as a foundation for many


dishes. Turn it into different meals by adding onion, mushrooms, eggplant,
capsicum, seeded olives, chopped ham or tuna. Or brown some mince
meat and then mix through tomato sauce and cook.

It can be used for the sauce on a pizza (use English muffins or pocket
bread as a base) or served over pasta. Turn it into lasagne by layering
lasagne pasta with sauce and grated cheese. Bake until cheese is golden, or
for an easy meal spoon over baked potato. Add a tin of kidney beans to the
sauce and spoon into tacos with some chopped lettuce, tomato and grated
cheese.
Chicken risotto
1 tablespoon oil

1 small onion, finely chopped

1 clove garlic, crushed

300g chicken mince

100g mushrooms, finely sliced

1 large tomato, peeled, seeded and chopped

½ medium capsicum, chopped

1 tablespoon tomato paste

generous pinch of dried oregano

1 tablespoon fresh parsley, chopped

1 cup short-grain rice

2 cups chicken stock

Heat the oil in a saucepan, add onion and garlic and cook for a few
minutes. Add chicken mince and brown, stirring occasionally for a few
minutes. Add mushrooms, tomato, capsicum, tomato paste, oregano and
parsley and mix through and cook for a minute.

Stir in the rice then add the stock. Bring to the boil and then cover and
simmer for about fifteen minutes, stirring occasionally or until all the
liquid is absorbed and the rice is tender.
Polenta with tomato sauce
1 cup polenta

3 cups stock or water or half-and-half

2 tablespoons parmesan cheese, grated

1 tablespoon fresh parsley, chopped

Grease and line a lamington tin. Boil stock and/or water and then gradually
add polenta while stirring.

Turn down heat and cook for about ten minutes and keep stirring until the
polenta has the consistency of mashed potato. Remove from heat and stir
in cheese and parsley.

Spoon mixture into the baking tin and cover and refrigerate until cold. Cut
the polenta into eight pieces and then grill (brush with a little oil), or bake
(brush with a little oil) or fry in about two tablespoons oil or butter until
golden. Top with tomato sauce.

N.B.: Cooked cold polenta makes great finger food.

Serves four.
Pumpkin and bean casserole
1 tablespoon oil

1 stalk celery, sliced

1 small onion, chopped

250g pumpkin, peeled and chopped into small pieces

250ml canned tomato soup (use the rest for another meal of soup and
add rice)

1 × 300g can (or nearest size) 3- or 4-bean mix, washed and drained

grated cheese to serve

Heat oil in a saucepan. Fry celery and onion for about five minutes on a
medium heat. (If the vegetables begin to stick add a few drops of water
and stir.) Add pumpkin and pour over tomato soup and mix through. Cover
and simmer for about thirty minutes or until vegetables are soft.

Add beans, mix and cook for another five minutes. Top with grated
cheese. Serve as a meal for baby and a side dish for adults. Put in a jaffle
or mix through some pasta. Suitable to freeze.
Basic frittata
1 tablespoon olive oil

300g small zucchini (about 3 zucchinis), sliced thinly

4 eggs, lightly beaten

100ml full-cream milk

pepper, optional

Heat oil and sauté zucchini over a low heat for about fifteen minutes or
until soft.

Mix eggs, milk and pepper and then pour over zucchini. When set on one
side either skillfully turn it over or put it under a grill for a few minutes
until golden.

Serve with a salad and bread.

Variations
Add sliced onions, leeks, mushrooms, tomato, capsicum or any other
leftover vegetables and cook with the zucchini.

Add grated cheese to the egg mixture or when grilling the frittata. Use
tasty cheese or parmesan cheese.
Pasta with avocado sauce
300g pasta

½ ripe avocado, de-seeded and peeled

2 tablespoons fresh parsley, chopped finely

2 tablespoons plain, full-fat yoghurt

2 tablespoons parmesan cheese, grated

1 tablespoon lemon juice

1 teaspoon fresh chives, chopped

3 tablespoons ricotta cheese

Cook the pasta in a large saucepan of boiling water. Mix the rest of the
ingredients together by hand or use a food processor and toss the pasta
through the sauce. Season with pepper.

Variation
Add a 100g can of drained tuna.
Basic hearty meat casserole
500g lean meat, chopped into cubes (use blade, chuck or gravy beef)

1 tablespoon oil

1 small onion, chopped

1 carrot, chopped in small pieces

1 capsicum, chopped

1 × 400g can tomatoes (or nearest size)

½ cup stock

2 tablespoons fresh parsley, chopped

1 bay leaf

pepper

Heat oil in a large saucepan and brown meat in two batches. Return meat
to pan and add onion, carrot and capsicum and cook until onions are
transparent. Stir occasionally.

Stir in the can of tomatoes with juice, stock, parsley, bay leaf and pepper.
Cover and simmer for 1½ to 2 hours. (Depending on your baby, you may
need to chop the meat finely after it is cooked.)

Serve with rice, pasta or cous cous. Serves four. Suitable to freeze.

This casserole can be varied by changing the vegetables, liquid or


flavourings. Add different vegetables, e.g. potato, pumpkin, zucchini,
eggplant, mushrooms, pitted olives. Add herbs and flavourings like basil,
oregano, paprika, coriander, lemon rind, garlic and tomato paste. Liquids
such as coconut milk, a dash of wine or vegetable juice, depending on the
flavours you like and the nationality of the dish, can also be added.
Throw in a can of 3-bean mix or kidney beans at the end of cooking for
another change.
Salmon and vegetable slice
4–5 slices wholemeal or white bread or a mixture, spread with butter
and crusts removed (use the crusts for finger foods or make into
breadcrumbs and freeze)

3 teaspoons butter, additional

1 leek, washed and sliced

1 small zucchini and 1 small carrot, grated (or use any vegetable to
make up 1 cup of grated vegetables)

½ cup tasty cheese, grated (grate a bit extra vegetable and cheese and
use this as finger food)

210g can pink salmon (or nearest size), drained

2 eggs, lightly beaten

1 tablespoon self-raising flour

1 tablespoon fresh parsley, chopped

Heat butter in a frying pan and sauté leeks until soft, about ten minutes.
Mix grated vegetables, cheese, leeks, salmon, eggs, flour and parsley
together.

Put buttered slices of bread in a greased baking dish and then spread the
salmon mixture over the bread. Bake in a 180°C oven for thirty minutes or
until golden. Delicious served hot, warm or cold. Serve with a salad.
Desserts
You can’t beat delicious, in-season fruit as a dessert. It is the best, easiest
and quickest option. Use any sort served at a texture suitable for your
baby. At this stage fruit may just need to be cut up or sliced. Serve
unadorned or with a dollop of yoghurt.

If you want fancier desserts look for desserts based on fruit (e.g. fruit
crumbles), bread, rice (e.g. creamy rice puddings) or pasta, milk (e.g.
custards) or yoghurt.
Baked noodle pudding
125g long life noodles, cooked and drained

3 eggs, lightly beaten

1 tablespoon sugar

2 tablespoons melted margarine or butter

¼ teaspoon cinnamon

¾ cup crushed tinned pineapple, drained (mix the leftover pineapple


with grated carrot for an easy salad)

¾ cup tinned pie apple (use the leftover apple for another dessert—
serve as is, or with yoghurt or custard)

Heat oven to 180°C. Mix butter or margarine and sugar with eggs. Add
fruit, noodles and cinnamon and mix together. Pour mixture into a greased
baking dish and cook for thirty-five to forty minutes. Serves four to six.
Bread and butter pudding
continental loaf (about 4 to 5 slices)

butter or margarine

cinnamon

2 eggs

1½ cups milk

1 tablespoon sugar

Heat oven to 180°C. Slice enough fruit loaf to fit in a small baking dish.
Butter the bread and place in the baking dish. Sprinkle over cinnamon.

Mix eggs, milk and sugar and pour over bread. Set aside for thirty minutes.
Cook for about thirty minutes or until mixture is puffed and golden. Serve
hot or cold.
Simple and healthy meal ideas for
when you don’t have much time
Jacket potatoes (easily made in the microwave—pierce one medium
potato, wrap in paper towel and microwave for about three minutes on
high). Top with baked beans, cheese, leftovers, avocado and cheese,
tuna.

Baked beans or spaghetti on toast or in jaffles.

Cheese or ham and tomato on toast or in jaffles.

Mashed avocado mixed with cottage cheese on toast.

Tuna on toast.

Eggs—scrambled, boiled, poached, omelette.

Rissoles—meat or fish.

Spaghetti bolognaise.

Fruit—fresh or tinned with yoghurt.

Cooked vegetables topped with grated cheese or cheese sauce.

Rice, pasta, quick-cooking or long life noodles with grated cheese.

Cous cous mixed with chopped vegetables.

Sandwiches, plain or toasted, or as a jaffle with a variety of fillings.

Baked or grilled fish fingers with vegetables or salad.

Quick-cooking or long life noodles with a splash of sesame oil and soy
sauce. Add some shredded barbecued chicken if you have it.

Home-made pizzas made on pocket bread, halved English muffins or


Lebanese bread, spread with tomato paste and herbs with favourite
toppings.

Leftovers.
Snack foods for toddlers
Fruit/frozen fruit—sliced or cut up in pieces or mixed together as a fruit
salad.

Cheese slices or cubes.

Grissini sticks.

Yoghurt.

Fromage frais.

Cereal—plain or with milk.

Toasted crumpets, lightly buttered.

English muffins with cheese, Vegemite, peanut butter or avocado.

Plain biscuits.

Vegetable sticks (raw or steamed if too hard, e.g. carrot).

Raisin loaf or sliced continental fruit loaf.

Scones.

Pikelets.

Wedges of hard-boiled egg.

Meat balls, kibbeh, falafel.

Quick-cooking or long life noodles, plain or with cheese, or a splash of


soy sauce and sesame oil.

Sandwiches.
What’s it all about?
Recipes | Contents

The end of your baby’s first year is only the beginning of a never-ending
story that flows through generations. When our children are babies it is
hard to see the whole picture, as the change to our lives is so immense and,
often, the physical and emotional demands so overwhelming that we
wonder what is it all about?

My babies are now two delightful adults, one of them the father of two
hilarious, clever, entirely adorable grandchildren. My pride and joy in all
of them equals that of what I imagine a writer or a painter feels after
completing a great work. If I have one message to today’s overly-anxious
parents it is to ‘lighten up’ and try not to get ground down by things that
don’t matter. Raising children is fun if you let it be. All parents go through
an incredible mix of emotions and hard work, at times one step forward
and two steps back, but it’s a rare parent who doesn’t look back and think
every minute was worth it.

And I guess that’s what it’s all about.


Resources
Australia has many resources available for families, although there never
seems to be quite enough. Some are constant, others wax and wane
according to government funding or how much voluntary support is
around to keep them going. Services also vary between urban and rural
areas and from state to state.

Agencies come and go, as do phone numbers, websites and name changes,
so it is not practical to have detailed resource lists in books as it’s hard to
keep such lists up-to-date and relevant. The aim of the following is to let
you know the main services that are available. Phone numbers and website
addresses were correct at the time of publication (2013).

I would also suggest you use the following resources to find out what’s
around in your area and how to contact the specific service you need:

Your child and family health centre


This service is also called Maternal and Child Health and Child and
Adolescent and Family Health depending on the state you live in.

The child and family health centre is the first step for any concerns relating
to your baby’s development, health or behaviour.

Your family doctor

The maternity hospital

Your nearest community health centre


Free services from nurses, psychologists, social workers, counsellors,
speech pathologists and psychiatrists can be accessed from community
health centres, but there can be long waiting lists. Information about
private services is available from community health centres, your family
doctor and child and family health nurses.
Your nearest children’s or local hospital
A variety of free services can be accessed via the public hospital system
including paediatric dietitians, occupational therapists, speech
pathologists, psychologists, physiotherapists, optometrists, audiologists
and so on. Again, depending on the urgency and the service there can be
long waits. Some children’s hospitals have twenty-four-hour helplines to
answer questions about childhood illnesses.

Your local council

Your local library

Phone book for the capital city of your state

Helping organisations
Here are the contact details of the helping organisations mentioned in this
book:

Australian Multiple Birth Association (AMBA)


A great resource for parents with twins or more. See the White Pages of
your nearest capital city or the AMBA website at www.amba.org.au

National phone: 1300 886 499

Breastfeeding information, education, advice &


support
Australian Breastfeeding Association (ABA)

General office phone: (03) 9885 0855

Telephone counselling: All capital cities and some other areas run a
Breastfeeding Helpline on a roster system. You can also look under
Australian Breastfeeding Association in your local White Pages. The
helplines are available seven days a week. Counsellors answer calls on a
voluntary basis in their own homes so please take this into account when
calling.

Email: info@breastfeeding.asn.au

www.breastfeeding.asn.au

Local groups: Information about contact for local groups can be obtained
from the website, from the hospital where you gave birth (or your
homebirth midwife) or your child and family health nurse.

Childcare & immunisation


Childcare Access Hotline 1800 670 305.

Family Assistance Office 13 61 50.

Immunisation Infoline 1800 671 811.

Australian Childhood Immunisation Register (ACIR) 1800 653 809.

CareforKids, a privately run resource for finding out about all aspects of
childcare. (02) 9235 2807.

Useful websites
www.immunise.health.gov.au (Immunise Australia).

www.hic.gov.au (Health Insurance Commission).

www.centrelink.gov.au (Centrelink).

www.careforkids.com.au

Child safety
Child safety centres, now called names like Child Health Promotion Units,
are found in the capital city of most states and are usually based in a
hospital. The units actively promote child health and safety issues and
provide information to parents, carers and health professionals.

Kidsafe is the Child Accident Prevention Foundation of Australia. It is


a non-profit non-government organisation dedicated to the prevention of
unintentional injury and death to children.

Phone: (02) 9845 0890

www.kidsafe.com.au

Depression following childbirth


The resources are out there for help with depression but there is no
national organisation for postnatal depression, and organisations, state by
state, seem to change all the time so I don’t think it is useful putting
addresses and phone numbers into a book.

Panda (Post and Ante Natal Depression Association Inc) appears to be


well established and permanent. Panda is located in Victoria. It is not a
national body but may be a starting place if you are having problems
finding a specific organisation in your state.

Phone: 1300 726 306

Mensline: 1300 789 978

www.panda.org.au

Dietitians Association of Australia (DAA)


If you need an accredited dietitian and don’t know where to go, call 1800
812 942 to obtain names and contact details. Make sure you let them know
it’s for paediatric advice.

www.daa.asn.au

Domestic violence
Advice and resources vary from state to state. Look in the front of the
White Pages for contact numbers in your state. Numbers include
emergency help, advocacy services and local community services.

A national confidential domestic violence help line is available on 1800


200 526.

Parent education
The availability and range of parent education varies widely across
Australia. It is often available via child and family health centres,
community health centres, long daycare centres, schools, children’s
hospitals, churches, residential family and baby centres, associations such
as the ABA, AMBA, Playgroup Association of Australia, and local
councils.

Finding out what is available is usually a challenge. Local newspapers


often advertise parent education courses/functions. Try a Google search if
you are on the net. A good resource is the website of the Children’s
Hospital at Westmead in Sydney, where fact sheets are available on
childhood health and safety:

www.chw.edu.au/parents/factsheets

Playgroup Association of Australia


The Playgroup Association of Australia has contacts in all states. See the
White Pages of your nearest capital city. Alternatively, child and family
health centres usually have contact numbers for playgroups.

Poisons Information Centre


Phone: 13 11 26

Relationship help
A number of other organisations offer relationship support services
including Relationships Australia, Unifam, Anglicare and Centacare.
Residential family care centres
Residential services are only found in capital cities and are not available in
all states. Information about these services can be acquired locally through
your maternity hospital, child and family health centre or community
health centre.

Separation and divorce


For information about mediation or parenting-after-divorce courses,
contact your nearest family court registry.

To contact a mediator in private practice look in the Yellow Pages under


‘mediators’.

Information for men on parenting after divorce is available through


MENDS (Men Exploring New Directional Strategies). Call 1300 363 361
or go to www.mends.com.au

Single parents
The two main support groups are:

Single Parent Family Association (SPFA)

Phone: 1300 300 496

www.users.bigpond.com/spfa

Parents Without Partners

Phone: (03) 9852 1945

Email: pwpvicine@bigpond.com

www.pwp.freeyellow.com

Speech and language


Speech Pathology Australia is the official body representing speech
pathologists and is happy to answer questions and supply factsheets.

Phone: (03) 9642 4899

Email: office@speechpathologyaustralia.org.au

www.speechpathologyaustralia.org.au

Support for Sudden Unexpected Death in Infancy


(SUDI), stillbirth and neonatal death
Sids and Kids provides Bereavement Support Services for parents
following the death of a baby, a stillbirth or a neonatal death.

The organisation also provides the latest information on safe sleeping,


including specific statements on a variety of issues in relation to SUDI (for
example, the use of dummies, breastfeeding, immunisation, wrapping
babies, mattresses and so on), and recommendations to reduce the risks of
SUDI (an umbrella term that refers to all unexpected deaths—medical,
sudden infant death syndrome (SIDS) and fatal sleep accidents).

Phone, national office: (03) 9819 4595

Phone, state branches: 1300 308 307

www.sidsandkids.org

Information statements can be downloaded from the website or requested


from the Sids and Kids organisation in your state.

Support for parents who think they might hurt their


babies
Sympathetic listening and suitable referral for help is available. Don’t be
afraid to call. Include the numbers in your mobile and on the emergency
list by the landline.

Phone: 1800 688 009 or 13 21 11


Reflux Infants Support Association (RISA)
A volunteer group for parents of babies with gastro oesophageal reflux
disease (GORD).

Phone: (07) 3229 1090

www.reflux.org.au
Acknowledgements
I am indebted to my family and the many friends and health professionals
who have been involved in Baby Love and helped bring it to life.

Roger Barker has been my partner, lover and friend for many years.
Unbeknownst to me when we started this arrangement, he had another
hidden talent—that of being a great father to our children. I have never
worked out whether it was instinct or if he reads father books on the sly,
but I give thanks daily that my partner in life is not only a great lover and
friend but a truly great father. As well, Roger has given me unlimited
emotional and financial support for this never-ending project and even
(most of the time) shown avid interest in its progress. Thank you Roger.

Thanks to good friends Narelle and Peter Black, who let me take over a
portion of their house to write the final draft and who continue to show
genuine interest in all my projects, be they mad or sane, successful or not.

Several nursing colleagues let me use their ideas. Thank you to Jann
Zintgraff for her delightful observation, ‘… the uncircumcised penis needs
the same care as the elbow’ and for her thoughts on sibling rivalry, to Sally
Keegan for her ideas on ‘looking after yourself’, to Patrizio Fiorillo for
help with the relaxation exercise, to Liz Flamsteed for her expertise on the
immediate postpartum area and to Jan Annson for her help with the ever-
important breastfeeding positioning.

Thanks too to Murray Cox for his insights into fatherhood which made me
think again about what it means to be a father. And to Diane Temple for
the wonderful recipes.

I am grateful to an enthusiastic band of readers for their encouragement


and forthright comments. Thanks to Carolyn Parfitt, Tina Matthews, Sally
Zwartz, Janine Goldberg, Jenny Miller, Leah and Doug Shelton, Michelle
Maxwell, Ruth Sainsbury, Jann Zintgraff, Maureen Fisher, Dasha Gilden,
Mary Lynch, Laureen Laylor-Smith, Peter Hartmann, Hilary and Ian
Jacobson, Mark Ferson, Lorraine Young and Anthony Samuels.

Special thanks to four people who are the sort of friends who give our lives
that extra dimension—Helen Wilmore, Margaret Sheens, Jann Zintgraff
and Fay Macartney-Bourne.

During the course of Baby Love’s history I have developed a deep


appreciation of the skills of editors and publishers. Oddly enough, hands-
on contact with the Baby Love manuscript seems destined to produce
babies. The following women had no children when I first knew them. I
am happy to report that they now have five babies and toddlers amongst
them despite exposure to a manuscript full of sleepless nights, crying
babies, sore nipples and endless poo. Well done team! Thank you to Julia
Stiles and Cath Proctor for their excellent editorial guidance and
unflagging encouragement and support for my labours and to Jane Curry,
former publisher at Pan Macmillan, for believing in the author and the
book and making sure neither sank.

A special mention to Carolyn Parfitt for a thorough and vigorous job of


copyediting, to Susie Baxter-Smith for the great illustrations in the first
edition magically produced in between caring for two toddlers, to Elspeth
Menzies, former editor at Pan Macmillan, who helped me look at the
material yet again with a fresh eye and to Margaret O’Sullivan, friend and
agent.

Finally, to all the mothers, fathers and babies who have allowed me for a
short time to share your lives—Baby Love was born out of conversations
with you and your experiences provide a great deal of the material
throughout the book—thank you.
Fourth edition acknowledgements
Many thanks to Dr Lisa Amir, inspired researcher into the problems that
beset breastfeeding women and babies, and for help with the ubiquitous
Candida and other fungal infections.

I’m most appreciative of the mighty effort made by Donna Walsh, mother
of the gorgeous Jonathon and Layton, and Kim Carruthers, mother of my
darling granddaughter, Sage, for a not too stressful photographic session
spent getting the look just right for the covers—thank you all for your time
and patience.

Thanks to the great crew at Pan Macmillan—can’t believe it’s over ten
years since we first met over the baby scales at the Bondi Junction Early
Childhood Centre, James. This time round, special thanks to Anna
McFarlane, former publisher, mother of a Mighty Toddler and a Baby Love
baby (it’s no wonder we get on so well); to Tom Gilliatt, publisher and
mutual friend of Bluey the Groper; and to Brianne Tunnicliffe and Karen
Ward, for seamlessly rearranging my add-ins and erasures. And a big hug
to Anyez Lindop for your smiley face, all the fun and for looking after me
so well in the publicity arena.
Fifth edition acknowledgements
A fifth edition—wow!

This time round thank you to Alex Craig, publisher, for your support and
enthusiasm for this baby tome, which is growing so rapidly it’s almost out
of control. Where will it end?

Thanks to Kylie Mason, editor, for seamlessly gluing in the additions


(many) and joining up the gaps left by the deletions (few).

Thanks as well to Brianne Tunnicliffe for your intelligent insights and


suggestions; Marissa McInnes, flight attendant, for the update on flying
with babies and toddlers; and Christine Rhodes, Nurse Manager, Statewide
Infant Screening Hearing (SWISH), for the latest on newborn hearing
screening around Australia.

A very special thank you to Alison Black for agreeing to let me be


photographed cuddling her delicious newborn James for the photo on the
back cover.

Finally, thanks to all the readers who write and email, and give feedback—
positive and negative—via the web; I enjoy reading what you have to say.
New digital edition
acknowledgements
It never occurred to me when the first edition of Baby Love was published
in 1994 that twenty years later I would be writing acknowledgements for a
revised and updated electronic version. In 1994, the idea of digital books
was high-tech nonsense, particularly for print tragics like me.

But in less time than it takes to raise a child, digital books and reader-
friendly devices have become our new best friends, even—to the
astonishment of my techie children—embraced by me.

Thanks to the tireless efforts of the team at Xoum Publishing. The new
digital Baby Love has been beautifully reworked to make life easier for
parents to find the information they want at the stroke of finger or the tap
of a key. As my grandchildren would say, like how cool is that?

Hearty thanks to Rod Morrison and Jon MacDonald, inspired directors of


Xoum, and my agent Margaret O’Sullivan for dragging me into the
twenty-first century. And a thumbs-up to Roy Chen for his awesome ‘eyes
closed’ artwork.
Search terms
Back to start | Contents | About the author
For information about any of the terms below, double-tap or double-click on the term (you will
need to drag and highlight if you want to include two or more words). A pop-up menu will appear.
Tap or click on the option you require.

A|B|C|D|E|F|G|H|I
J|K|L|M|N|O|P|Q|R
S|T|U|V|W|X|Y|Z

A
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Abdominal cramp
Abscess
Abstinence
Aching upper back and shoulders
Acid reflux
Acne
Activity centre
Adverse reactions to immunisation
Afterbirth pain
Air conditioning
Alcohol
Allergic reaction
Allergies
Alpha-lactalbumin (bovine)
Ammonia-smelling urine
Anaphylactic shock
Anaphylaxis
Anger management
Antibiotics see also Medication
Antibodies
Antigens
Antigens in breastmilk
Anus see also Bottom
Anxiety
Apathy
Apple
Areola
Arm and wrist problems
Aspirin
Asthma
Australasian Society of Clinical Immunology and Allergy (ASCIA)
Australian Association for Infant Mental Health (AAIMH)
Australian Breastfeeding Association (ABA)
Australian Childhood Immunisation Register (ACIR)
Australian Consumers’ Association (Choice)
Australian Multiple Birth Association (AMBA)
Australian Standards Mark™
Avocado

B
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Babies who drink too little


Babies who drink too much
Baby bath
Baby blues
Baby capsules
Baby cosmetics
Baby impetigo
Baby monitor
Baby sign language
Baby skin
Baby won’t burp
Babycare information
Babysitter
Babysitter safety
Back problem
Backpack
Bad days
Baked noodle pudding
Banana
Bandy-legged
Barrier method
Bassinet
Bath
Bathroom
Bathroom safety
Bathtime
Bedroom
Bedroom safety
Behaviour
Benefits of breastfeeding
Bereavement Support Services
Betacarotene
Bhutanese solution
Bib
Bifidus factor
Bilirubin
Birthmark
Bisphenol-A (BPA)
Bite
Blister
Blocked duct
Blocked tear duct
Blood
Blood in poo
Blood test
Blue feet
Blue hand
Blue mouth
Body movement
Boiling
Bonding
Booster shot see also Immunisation; Vaccination
Boredom
Borrow a baby!
Bottle feeding see also Formula; Weaning
Bottle feeding premature babies
Bottle feeding twins
Bottom see also Anus
Bottom shuffling
Bowel motion
Bread and butter pudding
Breakfast see also Cereal; Dinner; Lunch
Breast
Breast pain
Breast pump
Breast reduction surgery
Breast refusal
Breastfeeding see also Breastfeeding position
Breastfeeding and tooth decay
Breastmilk
Breathing
Bright red rash around the anus
Bronchiolitis
Bubble bath solution
Bunny rug
Burn
Burp

C
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Caffeine
Camping
Caputs
Car see also Going out; Travelling
Car restraints
Car trips
Carbohydrates
Care of teeth
CareforKids
Carpal Tunnel Syndrome
Carrot
Carry pouch
Carrying babies
Catnapping see also Sleep
Cephalhaematoma
Cereal see also Breakfast
Cerebral palsy
Change table
Change/nappy bag
Changing nappies
Changing the nappy
Cheese sauce
Chemical sterilant
Chicken
Chickenpox
Chicken risotto
Chicken soup
Child Accident Prevention Foundation of Australia (Kidsafe)
Child and family health nurse
Child Care Benefit (CCB)
Child Care Tax Rebate (CCTR)
Childbirth education classes
Childcare
Childcare Access Hotline
Choice
The Choice Guide to Baby Products
Choking
Cholesterol
Chuckling
Circumcision
Cleaning baby and toddler teeth
Clicking noise when breastfeeding
Clicky hip
Clinginess
Cloth nappies
Clothes
Clothing
Club foot / club feet
Cold cabbage leaves
Cold compress
Colds
Colic
Colic/wind
Colostrum
Combining breast and bottle feeding
Common infections
Communication see also Speech
Community health centre
Condom
Conflicting advice
Congenital dislocation of hips (CDH)
Conjunctivitis
Continual noisy, rattly breathing
Constipation see also Poo
Contraception
Controlled-crying see also Catnapping; Sleep; Teaching-to-sleep
Convulsion
Cooing and gurgling
Cortisone injection
Co-sleeping
Cosmetics
Cot
Cot bumpers
Cot mattresses
Coughing
Cous cous
Cow’s milk
Cracking
Cracking behind ears
Cracking joints
Cradle cap
Crawling
Creams and lotions
Croup
Crying
Cuddlies
Cup
Cutting fingernails
Cycle
Cystic fibrosis

D
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Day sleeper, night waker


Daytime sleeping
Deafness
Dentist
Depression
Dermatitis
Dessert
Development see also Growth; Milestones; Toys
Diaper Free! The Gentle Wisdom of Natural Infant Hygiene
Diaphragm
Diarrhoea see also Poo
Dicyclomine
Diet see also Food; Recipes; Solid food
Dietitians Association of Australia
Dimple at base of spine
Dinner see also Breakfast; Lunch
Disabilities
Discharge
Discipline
Disinfecting equipment
Disposable (single-use) nappies
Divorce
DMPA (contraceptive injection)
Doctor see also General Practitioner
Domestic violence
Domperidone
Donnalix Infant Drops
Dressing
Dressing and undressing
Dribbling
Drowning see also Water
Drugs
Dry skin
Dummies

E
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Ear
Ear infection
Early childhood drowning prevention
Early morning waking
Early weaning
Eczema (atopic dermatitis)
Education classes see also Parenthood
Egg
Electric and battery-operated pump
Electrical appliance
Emergency numbers
Engorged breasts
Equipment
Eucerin ointment
Excessive crying
Exercise
Expressing breastmilk
Expressing with a hand or electric pump
Eye

F
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Face
Factsheet
Faeces see Poo
Fall
Family Assistance Office
Family care centres
Family Health Centres
Family Planning Association
Fast flow
Fasteners
Fat
Fatal sleep accidents
Father
Fatigue
Feed time
Feeding
Feeding patterns
Feelings
Feet
Fever see also Temperature
Fever fit
Fine motor development see also Gross motor development
Finger food
Fingernail
Fire
Fire hazard label
First aid
First-aid kit
Fish
Flat or inverted nipples
Floppiness
Fluid
Fluoride
Flying with babies
Fontanelles see also Head
Food see also Diet; Finger Food; Recipes; Solid food
Food intolerance
Food safety
Food Standards Australia New Zealand
Food to avoid
Foreign body in eye
Foremilk see also Hindmilk
Formula see also Bottle feeding; Weaning
Friezes
Frittata
Front-pack
Fruit
Fruit gel
Frustration from over-tiredness
Funny habits
Fussy eaters see also Diet; Food; Recipes

G
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Gagging
Gagging and choking
Galactagogues
Galactosaemia
Gastrolyte
Gastro-oesophageal reflux disease (GORD) see also Regurgitation; Vomiting
Gates for stairs and safety
Gaviscon
General practitioner see also Doctor
Genetically modified (GM)
Genitals
German measles (rubella)
Giving the bottle
Goat’s milk
Going out see also Car; Travelling
GORD (gastro-oesophageal reflux disease) see also Regurgitation; Vomiting
Grandparent
Grasping reflex
Gripe water
Groin
Gross motor development see also Fine motor development
Growing teeth
Growth
Grunting
Guilt
Gums

H
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Habit
Haemorrhoid
Hair
Hair loss
Hairy bodies
Hand
Hand expressing
Hand-eye co-ordination
Hand pump
Hard poo
Hat
Head see also Fontanelles
Head cold
Headache
Health professional
Healthy Hearing Program (Queensland)
Hearing
Heartburn
Heart-lung resuscitation
Hearty meat casserole
Heat exhaustion
Heat rash
Helping organisations
Hepatitis B
Hepatitis C
Herbal remedies
Herbal tea
Herbal ‘wind’ preparations
Hernia
Hiccough
Highchair
Hindmilk see also Foremilk
Hip
Hives
Hoarse cry
Holding head to one side
Holidays see also Car; Going out; Travelling
Hormones
Hospital
Hot flush
Hot weather tips
Housework
How do I take my baby’s temperature?
How much sleep do babies need?
How to wean
Human Immunodeficiency Virus (HIV)
Hunger
Hurting babies
Hydrocele
Hydrocortisone
Hypothyroidism

I
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Ibuprofen
Illness
Immunisation see also Vaccination
Impetigo
Implanon
Infacol wind drop
Infant Formula Standard
Infant newborn screening
Infection
Infectious disease
Infoline
Ingrown toenail
Inguinal hernia (groin)
Insect repellent
Instinctual/natural style of babycare
Intestinal obstruction
Intra uterine device (IUD)
Inverted nipple
Iron deficiency
J
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Jaundice see also Yellow skin


Jaw
Joints
Juice
Jumper

K
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Kidsafe
Kitchen safety

L
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Labia see also Genitals


Lactase
Lactation consultant
Lactose
Lactose intolerance
Lambskin
Lanugo
Late mastitis
Laughing
Laundry safety
Length
Lentil and meat hotpot
Let-down
Libraries
Limits
Literacy development
Local council
Long-chain polyunsaturated fatty acids (LCPUFAs)
Lopsided head
Losic
Lotions and creams
Lots of saliva
Low sensory threshold
Lump
Lumps in the jaw
Lumps like small peas in the back of the neck
Lunch see also Breakfast; Dinner
Lung problem

M
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Making your home safe


Managing angry feelings
Massage
Mastitis
Maternity Hospital
Maternity Immunisation Allowance
Mattress
Meal ideas
Measles
Meat
Meconium
Medela Supplemental Nursing System
Medicating babies
Medication see also Antibiotics
Mental disabilities
Mental exhaustion
Metoclopramide
Miconazole
Microwave steam steriliser
Midwife
Milestones see also Development
Milia
Milk see also Breastmilk; Cow’s milk; Formula
Milk production
Mini pill
Mobile
Modern grandparenting
Mole
Mongolian spot
Morning and afternoon tea
Moro reflex
Mosquito bite
Mothercraft nurse
Mothers’ group
Mouth see also Teeth; Tongue
Movement
Mumps
Mylanta
Myths surrounding teething

N
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Nannies
Nappies
Nappy-free
Nappy service
National Health and Medical Research Council
Natural method
Nausea
Navel see also Umbilical cord
Navels that stay moist
Neck
Needle-sharp pain
New ingredients in formula
Newborn rash
Nifedipine
Night feeding
Night feeding and morning waking
Night sleeping and waking variations
Night sweats
Night sweats and hot flushes
Night waking
Nightwear
Nipple
Nitrosamines
Noise
Non-crawlers
Non-medical approach
Noodle pudding
Nose
Not eating
Not enough milk/fluid
Nucleotides
Nurse

O
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One-breast feeding
One eye looks bigger than the other
Oral contraceptives
Over-stimulation
Over-tiredness
Oxytocin

P
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Pacifier/Dummy use
Paediatrician
Paid work and breastfeeding
Pain
Paracetamol
Paracetamol and asthma risk
Parentcraft class
Parenthood see also Education class; Preparation for parenthood
Pasta with avocado sauce
Patterns of crying
Pavlik harness
Peach
Peanut
Pear
Pelvic floor muscles
Penis see also Genitals
Persistent sore/damaged nipple
Pertussis (whooping cough)
Pest control
Pet
Petroleum jelly
Phenergan
Phenobarbitone
Phenylketonuria (PKU)
Physical disabilities
Physical exhaustion
Physical or mental disability
Pigeon lice
Pilchers
Pill, the
Pillow
Pink urine
Plane trip
Play
Playgroup
Playgroup Association of Australia
Playmat
Playpen
Pneumococcal vaccine
Pneumonia
‘Poddy’ tummy see also Pot belly
Pointing
Poisoning
Poisons Information Centre
Polenta
Poo see also Constipation; Diarrhoea
Portable baby chair
Portable cot
Post and Ante Natal Depression Association Inc (Panda)
Postnatal check
Postnatal depression
Postnatal depression and anxiety
Postnatal disillusion
Postnatal drift
Postnatal psychosis
Postpartum adjustment
Postpartum thyroiditis
Pot belly see also ‘Poddy’ tummy
Potato
Prams and strollers
Premature babies see also Small babies
Preparation for parenthood
Primitive reflexes
Probiotics
Protein
Prune juice
Psychologist
Pump
Pumpkin
Pyloric stenosis

R
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Rapid Eye Movement (REM)


Rash see also Skin
Rash around the mouth
Rattle
Reading
Recipes see also Diet; Food; Solid food
Red cheeks
Red patch
Red under the chin
Reflexes
Reflux see also Gastro-oesophageal reflux disease (GORD); Regurgitation; Vomiting
Reflux Infants Support Association (RISA)
Regurgitation see also Gastro-oesophageal reflux disease (GORD); Vomiting
Relationship
Relaxation
Releasing the milk
Resources
Restraint
Resuscitation techniques
Returning to paid work and childcare
Reye’s syndrome
Rhythm method
Rice cereal
Ringworm
Rolling
Rooting reflex
Roseola
Routine
Routines and spoiling
Royal Australasian College of Physicians
Rubella (German measles)
Rusk

S
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Safe bottle feeding


Safety
Safety gate
Saliva
Salmon and vegetable slice
Salt
Sandwich
Scald
Scalp
Screaming
Screeching
Screening test
Seat belt
Sedative
Separation
Separation and divorce
Separation anxiety
Separation anxiety and stranger awareness
Serious depression
Sex after birth
Sexually transmitted diseases (STDs)
Sharing parents’ bed
Sheepskin
Shoe
Showering
SIDS
Sids and Kids Bereavement Support Services
Silicone dummies
Single parent
Sitting
Six week change
Skin see also Rash
Sleep see also Catnapping; Teaching-to-sleep
Sleep position monitors
Sleeping equipment
Sling
Small babies see also Premature babies
Small lump under nipple
Smelly urine
Smiling
Smoke detectors
Smoking
Snack foods for toddlers see also Finger food; Food
Sneezing
Social behaviour
Social behaviour and play
Sodium intake
Solid food see also Diet; Food; Recipes; Weaning
Sorbolene
Sore nipple
Sound
Sound monitor
Soy milk
Specialised formula
Speech
Speech Pathology Australia
Spine
Spoiling
‘Spoiling’ and discipline
Stairgate
Standards Association of Australia
StandardsMark™
Starting new food
Startle reflex
Statewide Infant Screening Hearing (SWISH) (NSW)
Sterilisation
Sternamastoid tumour
Sticky eye
Stimuli
Stitches
Storing breastmilk
Stranger awareness
Strategies to treat dehydration
Strawberry mark
Stress incontinence
Strollers and prams
Sucking
Sucking blisters
Sudden bottle refusal
Sudden Infant Death Association (SIDA)
Sudden Infant Death Syndrome (SIDS)
Sudden Unexpected Death in Infancy (SUDI)
Suffocation
Sugar
Summer
Sun
Sunglasses
Sunscreen
Supply Lines
Supporting weight
Suture lines
Swaddling
Sweating
Sweet potato
Swimming
Swing

T
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Tailored nappies
Teaching-to-sleep see also Catnapping; Controlled crying; Sleep
Teaching your baby to use a cup
Tears
Teats
Teeth see also Mouth; Tongue
Teeth and food
Teething
Temperament
Temperature see also Fever
Tenosynovitis
Testes see also Genitals
Thrush
Thumb-sucking
Thyroiditis
Tiny movable lumps
Toddler
Toenail
Tomato sauce
Tongue see also Mouth; Teeth
Tongue tie
Tongue tie and breastfeeding
Tooth decay
Torticollis
Toy
Toy safety
Toys and activities
Transparent ‘crystals’ in urine
Travelling see also Car; Holiday
Triplets
Tummy-time
Twins

U
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Umbilical cord see also Navel


Underweight
Undressing
Unpredictability
Unsettled period
Urates
Urinary tract infection (UTI)
Urine see Wee

V
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Vaccination see also Immunisation


Vagina see also Genitals; Labia
Vaginal blood loss after birth
Variations in milestones
Vegemite
Vegetable
Vegetarian diet
Vision
Vitamin
Vitamin C
Vitamin D
Vitamin K
Vocalisation
Vomiting see also Regurgitation
Vomiting Infant Support Association (VISA)

W
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Walkers
Walking see also Gross motor development
Washing
Water see also Drowning
Wax in ear
Weaning see also Bottle feeding; Formula; Solid food
Websites
Wee
Weighing babies
Weight
Weight loss
What’s it all about?
Wheezing
Where to sleep baby
White nipple (nipple vasospasm)
White sauce
White spots on tongue
White tongue
Whole cow’s milk
Whooping cough (pertussis)
Why breastfeed?
Why do babies cry?
Wind
Withdrawal
Work
World Health Organization (WHO)
Wrapping or swaddling
Wrist and arm problems

Y
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Yellow skin see also Jaundice


Yoghurt

Z
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Zantac
About the author
Robin Barker is a retired registered nurse, midwife and child and family
health expert with over thirty years’ hands-on experience with families and
babies. Baby Love is the result of countless hours spent one-on-one with
parents discussing things like breastfeeding, crying, sleep hassles, strange
habits in normal babies and, of course, the inevitable poo. Robin has three
adult children and two grandchildren. She is very proud of them all. She
lives in Sydney.
Other books by Robin Barker
Baby & Toddler Meals

The Mighty Toddler


PO Box 324, QVB Post Office,
NSW 1230, Australia
www.xoum.com.au

This revised digital edition (v1.1) published 2013 by Xoum

Print edition published 1994 by Pan Macmillan Australia

Text copyright © Robin Barker 1994, 1997, 2001, 2005, 2009, 2013

Cover and internal design, typesetting and illustrations copyright © Xoum 2013

The moral right of the author has been asserted.

All rights reserved. No part of this book may be reproduced or transmitted by any person or entity
(including Google, Amazon or similar organisations), in any form or by any means, electronic or
mechanical, including photocopying (except under the statutory exceptions provisions of the
Australian Copyright Act 1968), recording, scanning or by any information storage and retrieval
system, without the prior written permission of the publisher.

ISBN 978-1-92205-746-4

Cataloguing-in-publication data is available from the National Library of Australia

The publisher would like to acknowledge the generous help of the following beta readers: Casey
Baldwin, Karen Gaudoin, Letitia Gibbs, Kendall Hore, Claire de Medici, Emma Noble and Ali
Orman

Cover design by Xou Creative, www.xou.com.au


Internal design and illustrations by Roy Chen

Word count 180,000

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