Baby Love
Baby Love
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
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:
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
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
12. Safety
17. Equipment
23. Equipment
27. Safety
31. Safety
Recipes
Resources
Acknowledgements
Search terms
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.
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.
12. Safety
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.
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.
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.
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.
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.
What will it be like when the baby cries in the middle of the night?
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.
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.
Nanny fees range from $20.00 to $35.00 an hour, about $200.00 a day.
Baby Bonus
Parenting Payment
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
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.
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.
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.
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.
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.
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.
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
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:
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.
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.
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 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.
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
A full-term ‘small’, healthy baby born to small parents does not need any
special care.
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.
‘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.
The chances of an early birth and/or smaller babies are increased when
twins or triplets are expected.
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.
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.
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.
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.
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.
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.
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.
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.
4 cardigans or jackets.
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.
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
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.
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.
But there are problems with disposables. Apart from the ongoing expense
that must be budgeted for, the two main ones are environmental and
behavioural.
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.
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.
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:
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).
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.
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.
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.
Children aged six months to under four years must be secured in either
a rearward- or forward-facing restraint.
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.
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.
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.
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.
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.
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.
Sunshades over the restraint reduces airflow, traps heat and increases
body temperatures. To reduce heat and sunlight attach sunscreens to the
car windows.
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.
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/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.
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.
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.
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.
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?
Is it the right height for you and your partner? Can you push it without
damaging your shins? Do you need adjustable handles?
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.
Disposable wash cloths or baby change lotion for when you are out.
Pump pack sorbolene and tissues are fine when you are at home.
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:
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.
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.
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.
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.
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.
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 are very useful for calming sick babies, premature babies or
babies under lights who are jaundiced.
Disadvantages
Can interfere with initiating and establishing breastfeeding.
Hazards such as tooth decay and safety risks are associated with
improper use.
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.
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.
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.
4 cardigans or jackets
Bibs
Nappies
Cloth (terry towelling) squares
Tailored
Disposables
Sleeping
Bassinet and stand (optional) and firm mattress
Mattress protector
2 blankets
Pram or stroller
Car safety
A standards-approved baby restraint
Basic toiletries
Blunt-ended scissors
Miscellaneous
Child safety products
Chapter 12: Safety (for safe use of equipment, including car safety and safe use of dummies)
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
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
Read the early breastfeeding parts of this book before your baby is
born.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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’.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
A floppy and sleepy baby not waking to feed at least six times every
twenty-four hours.
You may be aware that your breasts are not full and feel the same
before and after feeds.
Setting the alarm and waking your baby during the night.
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.
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.
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.
Gently hand express for about thirty seconds before feeding to soften
the areola, draw out the nipple and start the milk flowing.
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.
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.
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.
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.
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.
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.
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).
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.
Chapter 10: Early Worries and Queries (blue around baby’s mouth)
Chapter 14: Sleeping and Waking in the First Six Months (settling techniques)
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
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.
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.
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.
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.
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.
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.
[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.
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.
While there is no conclusive proof of their benefits nor has there been
any proof of harm for healthy, full-term babies.
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.
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.
Here are some steps you can take to minimise the very small risks of BPA:
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.
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.
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.
Boiling
Place utensils in a large saucepan.
Bring to boil and boil for five minutes, adding teats for the last two
minutes.
Store equipment you are not going to use straight away in a clean
container in the fridge.
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.
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.
When in doubt, check with a pharmacist, child and family health nurse
or doctor.
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 possibility of mistakes when mixing the water and scoops
of formula—if a mistake is made it is only for one feed.
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.
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.
Check the expiry date on tins of formula and discard them if they are
out of date.
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.
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.
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.
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.
Chapter 15: The Crying Baby (protein intolerance, lactose intolerance, ‘wind’, ‘colic’ and the
relationship of formula)
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.
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.
For your comfort if your baby refuses one breast or goes through a
phase of breast refusal. (See Breast refusal, chapter 8.)
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.
Hand expressing
There are lots of good things about hand expressing:
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.
(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.
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.
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.
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.
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.
For example:
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!
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.
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.
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.
Your baby has six to eight pale, wet nappies every day.
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.
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.
Interpreting weight
It’s quite likely your baby is not getting enough milk if:
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.
Most of her nappies are dry or just damp, rather than wet;
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.
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.
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.
Unresolved grief for the loss of another baby (cot death, stillbirth or a
baby given up for adoption).
Here’s a general guide for a temporary low supply. Ask your partner and
other family members around you to read this as well.
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.
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.
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.
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!
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.
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:
The extra calories from the food helps your baby gain weight, you
gain confidence and often the milk supply improves.
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
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
Hydrocortisone will not help if the problem is caused by the way your
baby is taking 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.
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.
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.
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.
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.
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.
Mother causes:
A change in perfume, talcum powder or a radical change in diet.
Any illness or stress which may deplete the breastmilk supply or inhibit
the let-down.
A rapid let-down response that frightens the baby, who then gets a
temporary mental block about the breast.
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.
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.
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.
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.
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.
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.
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.
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.
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);
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);
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.
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.
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.
Chapter 10: Early Worries and Queries (heat rash, hormone rash; poo variations;
regurgitation and vomiting; Infant Newborn Screening Test)
Chapter 14: Sleeping and Waking in the First Six Months (‘unsettled period’)
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:
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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!
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.
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.
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.
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!
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).
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.
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.
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.
Tears
Tears can be present when your baby cries as early as four weeks or might
not appear until nine months.
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).
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.
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.
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.
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.)
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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:
Difficulty breathing.
A convulsion or fit.
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.
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.
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.
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.
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.
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.
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.
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.
If you use a sink, take care that your baby doesn’t bump against the taps
or burn herself on the hot tap.
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.
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.
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…
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.
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.
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.
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.
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.
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.
Use a fan (not directly on your baby) in the room where your baby
sleeps (unless of course you have air conditioning).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Heads
Wash with simple soap
Vaseline, oil
Crusty eyebrows:
Do not treat
Bodies
Options in the bath:
Nothing
Baby lotion
Moisturiser options:
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
Heat rash
Bottoms
Options for cleaning
Damp tissues
Choose from:
Desitin
Bepanthen (genitals)
Fungal infection
(diagnosis required)
Topical anti-fungal
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.
Chapter 13: Growth and Development (the startle reflex, the Moro reflex)
Chapter 14: Sleeping and Waking in the First Six Months (options for settling)
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.
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.
The baby cries excessively or the toddler is extremely active and never
sleeps;
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.
Never
Throw water over the flame.
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.
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.
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.
Bathroom
The hot and cold taps should be clearly marked. Use a tap protector to
inhibit children turning on the hot water tap.
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.
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.
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.
Your room
Store medications, perfumes, make-up, scissors, earrings, pins, cuff
links, coins or breakables away in a safe place.
Arrange storage for vacuum cleaners and any other major electrical
appliances.
Special fireguards should be used in front of all fires. The guard should
be firmly fixed to the floor or wall.
Alcohol is a poison for a child. Store alcohol and cigarettes well out of
reach.
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.
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.
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.
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;
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.
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.
Place the cot or bassinet away from windows, heaters and power points.
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.
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.
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.
Car safety
For details on the purchase, legal requirements and safe use of infant
restraints please see Choosing Baby Products, chapter 5.
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.
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.
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.
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.
Emergency numbers
Have a list of important numbers near the landline and in your mobile:
Police
Ambulance
Fire Department
County Council
Family Doctor
Neighbour
Relative
Chemist
Your first-aid kit
Dressings
Crepe bandages in various sizes
Non-stick squares that won’t stick to wounds and cause bleeding and
pain when removed
Adhesive tape
Sticking plaster
Clean, non-fluffy cloth or clean plastic film to cover burns until seen by
a doctor
Calamine lotion
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.
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.
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.
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.
Routine immunisation
Procedures
Some vaccines are combined, meaning fewer injections.
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.
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.
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.
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.
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.
Premature babies
Premature babies should be vaccinated according to the recommended
schedule from the date of their birth, not the expected date of birth.
If she has had a live vaccine within the last month (MMR, tuberculosis,
oral polio vaccine or yellow fever).
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.
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.
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
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
Normal variations are greatest in the gross motor area. Here are the
commonly noticed variations in the first three months.
Head control: Some babies develop strong head control very early,
others still have wobbly heads that bob forwards at 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.
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.
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.
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:
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.
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.
vocalises tunefully
Chapter 14: Sleeping and Waking in the First Six Months (startle reflex; crying patterns)
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
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.
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.
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).
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
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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?
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 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.
A reflection of the work I did for so many years helping a diverse range of
parents in a diverse range of situations.
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.
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.
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.
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.
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.
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.
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:
Try wrapping your baby firmly so she can’t wake herself up when
she startles;
Go for a walk;
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.
Chapter 28: Sleeping and Waking Six Months and Beyond (teaching to sleep)
15
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.
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.
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.
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.
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.
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.
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.
2. Breastfeeding
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.
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.
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;
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.
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.
The main medically based theories as to why babies cry a lot are all
centred around the baby’s gastrointestinal tract (the gut).
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.
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.
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.
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.
Frequent small feeds are generally better tolerated than large infrequent
feeds when the baby has acid reflux.
For more information on food allergy and food intolerance see chapter 18.
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.
Change of formula occasionally makes the baby happier but the change
is often short-lived.
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.
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.
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.
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’.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
Moving house;
Money worries;
Relationship problems;
An unsympathetic partner;
Isolation and loneliness suffered by the parent at home with the baby
(usually the mother);
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Fainting or dizziness;
Postnatal check
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.
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.
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.
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.
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.
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.
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).
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.
‘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.
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.
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.
Is it safe?
Does the person giving you the advice have any commercial interests
which may influence the advice?
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.
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.
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.
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’.
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.
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.
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?’
Grandparents’ rights
The two main areas where legal issues arise are:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Panic attacks.
Accept you the way you are and not try to ‘jolly’ you along.
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.
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.
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.
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
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.
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.
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.
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.
Sharing a bed or sharing a room with a third person also takes time for
many couples to get used to (some never do).
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).
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Try to arrange several times when you and your baby can be with the
caregiver before you go back to work.
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.
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.
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.
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 15: The Crying Baby (effect on relationship; anger and feelings of depression)
Chapter 22: For Parents (paid work and night waking; travelling with your baby)
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
21. Safety
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.
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:
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.
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.
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.
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.
Chapter 24: Feeding Your Baby (tips for drinking from a cup)
18
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.
For more on this topic in Baby Love, see Allergies and food intolerance
later in chapter 18.
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.
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.
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:
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.
Parents who live in countries where no one gets enough to eat must find all
this agonising rather precious.
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).
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
Hoarse voice.
Paleness, floppiness.
Loss of consciousness.
2. Lie the baby flat and raise her feet (if possible).
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.
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.
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.
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.
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’.
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.
Week Two
10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed
Week Three
10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed
Week Four
10 am Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed
2 pm Bottle feed Bottle feed Bottle feed Bottle feed Bottle feed
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.
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.
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.
Chapter 14: Sleeping and Waking in the First Six Months (‘sleeping through’)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
Sand.
Occasionally, food.
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.
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.
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.
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.
Always dry well, but gently, behind your baby’s ears every day and
check to see what’s happening.
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.
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.
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 28: Sleeping and Waking Six Months and Beyond (sleep problems and ‘teething’)
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.
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.
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.
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.
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.
Mobiles still attract attention. By six months your baby will be reaching
and grabbing so make sure it’s well out of reach.
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
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.
uses whole hand to grasp objects and passes them from one hand to
another;
makes tuneful talking noises and may use single or double syllables;
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.
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.
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.
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;
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
cleaning lotion;
nappy cream;
cotton balls;
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)
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 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)
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)
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?
Give a young baby a finger to suck. Try to distract an older baby with a
toy, finger food or a drink.
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
27. Safety
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.
Safety
Check stability. Highchairs with a narrow base may be less sturdy—this
particularly applies to older, secondhand highchairs.
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.
Practicalities
The highchair should be light and easy to move.
Always make sure your baby is secure and never leave her alone with
food.
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.
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.
Offer the food before milk from now on if you have been doing the
reverse.
Breakfast
8 am
Weet-Bix
VitaBrits
Porridge
Baby Cereal
OR
Stewed fruit
OR
Full-fat yoghurt
OR
Cheese
Fruit rusk
Lunch
12.30 pm
ADD
Any meat
ADD
Evening Meal
5–6 pm
OR
OR
OR
OR
OR
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.
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
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 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.
FURTHER READING
Baby & Toddler Meals, Robin Barker, Pan Macmillan Australia, 1998.
25
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.
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!
Another habit is sucking the top or bottom lip, which looks most
peculiar but is harmless.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
You are given a diagnosis of ‘teething’ (growing teeth does not cause
diarrhoea).
Your baby suffers from other illnesses such as diabetes, heart disease,
urinary tract infections or is on any medication.
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?
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:
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
AT NINE MONTHS
Small/Normal Large/Normal
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 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.
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.
She will turn to a tiny sound behind each ear if she is not too distracted.
She understands ‘no, no’ (but doesn’t necessarily obey) and ‘bye-bye’.
Your baby can hold finger food well at this age and eat it without too
many mishaps.
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.
attempts to crawl;
pulls to stand.
shouts;
babbles;
imitates;
plays ‘boo’;
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.
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.
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.
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).
Illnesses (coughs, colds and ear infections are the most common).
A change of environment (different room, different bed, different
house).
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.
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.
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.
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.
1. Teaching your baby to sleep (involves stopping all the external helping-
to-sleep aids and leaving her to cry).
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 is sometimes the only way to stop evening and night-time bottles and
overnight breastfeeding in older babies and toddlers.
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.
Leaving babies to cry for weeks on end is unsafe for their physical,
emotional and psychological wellbeing.
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.
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.
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.
Disadvantages
Sedatives have a relatively high failure rate.
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.
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.
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?).
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.
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.
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.
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.
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.
You are uncertain about putting your baby into a separate room.
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:
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’.
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.
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.
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.
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.
Chapter 14: Sleeping and Waking in the First Six Months (stages of sleep; ‘sleeping through’;
‘spoiling’)
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.
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
31. Safety
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
).
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.
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.
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.
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.
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.
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
AT TWELVE MONTHS
Small/Normal Large/Normal
Development
Gross motor
By twelve months your baby will be sitting well, on her own,
indefinitely.
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).
Your baby can recognise you from a distance of six metres (twenty
feet) or more.
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.
Likes having a cuddle, although if you have a ‘busy’ baby, cuddles may
be few and far between at times.
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 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.
crawls;
cruises, walks.
holds a spoon;
demonstrates affection;
plays ‘pat-a-cake’;
waves ‘bye-bye’.
Safety
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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.
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.
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.
Flotation toys and swimming aids are not lifesaving devices and do not
replace adult supervision.
Remember to drain wading pools after use and remove the access
ladder from above-ground pools when swimming is over for the day.
Becoming a Toddler
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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.
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.
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.
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.
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.
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.
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).
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.
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 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.
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.
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.
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.
FURTHER READING
The Mighty Toddler, Robin Barker, Xoum, 2014.
The Emotional Life of the Toddler, Alicia F. Lieberman, Simon & Schuster, 1995.
Recipes
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4–6 Months
6–9 Months
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!
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
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)
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.
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.
Mix two vegetables together, e.g. pumpkin and potato, capsicum and
sweet potato.
Mix any vegetable with cooked red lentils. (See recipe for Lentil and
meat hotpot for how to cook lentils.)
Mix cooked lean beef mince or chicken mince with any vegetables.
Mix tinned fish such as tuna or salmon (remove bones) through any
vegetable.
Mix cooked, flaked fresh fish (remove all bones) through vegetables.
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.
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
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
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.
4 cups water
½ onion, chopped
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.
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.
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.
Cruskets.
Cooked pasta.
Polenta fingers
1 cup milk
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.
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
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.
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
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
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.
Serves four.
Pumpkin and bean casserole
1 tablespoon oil
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
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
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.
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
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 capsicum, chopped
½ cup stock
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.
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)
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
1 tablespoon sugar
¼ teaspoon cinnamon
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.
Tuna on toast.
Rissoles—meat or fish.
Spaghetti bolognaise.
Quick-cooking or long life noodles with a splash of sesame oil and soy
sauce. Add some shredded barbecued chicken if you have it.
Leftovers.
Snack foods for toddlers
Fruit/frozen fruit—sliced or cut up in pieces or mixed together as a fruit
salad.
Grissini sticks.
Yoghurt.
Fromage frais.
Plain biscuits.
Scones.
Pikelets.
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.
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:
The child and family health centre is the first step for any concerns relating
to your baby’s development, health or behaviour.
Helping organisations
Here are the contact details of the helping organisations mentioned in this
book:
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.
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.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.
www.kidsafe.com.au
www.panda.org.au
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.
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.
www.chw.edu.au/parents/factsheets
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.
Single parents
The two main support groups are:
www.users.bigpond.com/spfa
Email: pwpvicine@bigpond.com
www.pwp.freeyellow.com
Email: office@speechpathologyaustralia.org.au
www.speechpathologyaustralia.org.au
www.sidsandkids.org
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.
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.
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?
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?
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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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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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
{ return to top }
K
{ return to top }
Kidsafe
Kitchen safety
L
{ return to top }
M
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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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S
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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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V
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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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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
Text copyright © Robin Barker 1994, 1997, 2001, 2005, 2009, 2013
Cover and internal design, typesetting and illustrations copyright © Xoum 2013
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
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