Q: I have been reviewing my baby's growth chart after reading an article on childhood obesity. She is just four month old. She weighed 3,6kg at birth and is now 7,3kg. I am breast-feeding her, and because she seems to always be hungry I have started her on solids. Have I done the right thing or am I setting her up for obesity?
A: You gave birth to a healthy little girl, and with breast-feeding there is no danger of over-feeding. Four months is early to be starting solids, as her digestive system will only mature at about six months. However, what you feed her is key in these early months as you are laying the foundation of her eating habits and overall health. It is important to start slowly with little rice cereal, which is formulated for young babies, you can blend this with a little pureed fruit such as pear, apple or banana.
For an alternative to breast milk, to quench thirst, give her cooled boiled water or rooibos tea (with no sugar).
As she progresses, you can add a range of fresh vegetables and a little chicken or beef to her diet.
Once she is teething, she can enjoy chewing on celery or carrot sticks. Avoid all process foods and sweets as they lead to excess weight and obesity.
Obesity can be prevented with a good nutritious diet and physical exercise. A baby's normal development is enhanced by spending a lot of time on the floor learning to roll over, pushing up on her arms to strengthen her neck and back muscles so she can learn to sit and later crawl and walk. Floor play should occupy a major part of her waking hours rather than sitting in a baby chair or walking ring.
Ensure that whoever is caring for your daughter during the day has a holistic understanding of infant development and you will not have to worry about your baby becoming obese.
Q: We have a three week old son. He was on mothers' milk for roughly two weeks, but he gave us a big fright when he vomited all his milk today. He has done it before, but not coming out looking like scrambled eggs. He is on SMA No. 1 milk. Is this a reaction to the milk that is normal, or is he allergic to the milk? Otherwise he is fine. He's a very quiet boy, your typical man, when his stomach is full. And if he is clean and warm, he is happy. There is the normal wind problem from drinking milk from a bottle that all babies have to master.
A: There are questions to consider before making a decision about what caused your son to vomit the way he did. Firstly, how long after the bottle feed did he vomit? Was he crying with abdominal pain at the time? As he has only been on the SMA No. 1 for just over a week, it may be that his body is not coping well with digesting formula, which is made from cow's milk rather than breast, which is 100% right for baby. Cows' milk contains six times as much casein (protein) as breast milk and the curds that form in the stomach from casein are much tougher and less digestible than the finer curds of human breast milk.
If your son continues to vomit over the next few days and there is no sign of illness, such as a fever, then I would suggest you try switching to Soya-based milk, such as Infasoy or Isomil No. 1. Alternatively, contact your paediatrician or Well-baby clinic to discuss the recurring vomiting.
Q: My son has just turned one and is becoming a busy monster. He is crawling, and from the moment he wakes he does not stop. Nothing is safe. I can't do a thing around at home while he's up. If I try to restrain him he screams and throws tantrums. I am so frustrated.
A: The frustration you are experiencing is indicative of the changes you need to make to ensure the safety and wellbeing of your son. "Baby-proofing" your home now will relieve much of this frustration.
Get down to his level on the floor for a few minutes and you will see how exciting the world looks from his perspective. He has an innate drive to smell, touch, taste everything becuase this is how toddlers discover how the world works.
For the safety of your son and your sanity, move breakable and precious items out of your son's reach or store them while he is in this developmental phase. Focus on the areas where he spends most of his time. Electric sockets must be sealed with plug covers and electrical equipment locked out of reach. Ensure there are toys he can freely access.
He will want to be close to you most of the time. Keep two steps ahead of him, always knowing where he is. In the kitchen, make sure cleaning detergents are in a cupboard he can't open. Allocate stuff he can play with when you are in the room. Rather than saying "no" and removing things, make use of distraction. Remember; this phase will not last forever.
Q: MY BABY is six months old and is constipated. I started giving her soft porridge from the age of two months as she cried through the night from hunger. Since then, she has slept “like a baby”.
I am giving her druppels and initially, they helped a lot, but they are not helping anymore. What can I give her? I have tried pear and prune purées, but they only help for a day.
A: It is important to diagnose constipation correctly. A child who has two or three small hard stools a day would be constipated, while another who has a normally formed bowel action on alternate days would not be constipated. A constipated infant may also have abdominal pains and be listless and fretful.
If she really is constipated, the most likely cause is eating porridge from such a young age, when her digestive system was still immature. Six months is the accepted norm for introducing solids because of the maturity of the digestive tract at that stage.
As she is already accustomed to taking solids, rather introduce puréed meals of mixed fruit or vegetables with meat, plus a little rice or potato. Provide no more than one meal a day of rice cereal with fruit. It is imperative that she still consumes milk (breast or formula) each day — about five feeds a day, or on demand in the case of breast feeding. As she progresses towards a year old, increase her solid food and decrease her milk intake. Any change in her routine should be gradual, introduced over weeks. With more fruit and vegetables in her diet, you should see a change in her bowel action. If the problem continues, take her to a paediatrician.
Q: I am a single mum of a six-month-old girl, who is teething. She sleeps for only two hours during the day and wakes up at least four times during the night. I don't know how to settle her. I change her nappy and give her a bottle and cuddles, but nothing seems to work. Please help!
A: First, it is not unusual for babies of this age to start having disturbed nights. There are two main causes: teething; and hunger. The most painful period of teething is when the teeth are in the gums before they erup. The gums may appear swollen and red, which is normal. Sometimes teething refers pain to the ears, so look out for where she is showing you she is sore. If there are any other symptoms of ill-health, such as a fever, take her to your GP.
During the day, give your daughter plenty of things to chew on: raw carrot sticks, celery sticks and teething rings (including those you can freeze). This will bring relief. Local anaesthetic gels and powders can also help.
If your daughter has not already started solids, now is the time to introduce them. If her last meal of the day comprises a carbohydrate and a protein (rice cereal with pureed meat or peanut butter), she will be satisfied for longer. Add to this a bottle feed just before you put her to sleep and there is a good chance that, if hunger is the culprit, she will sleep longer.
The key to settling her when she wakes during the night is to ensure that it doesn't become paytime. If she is distressed, talk to her calmly. Stroke her in the cot, keep lights down and talk to her gently but firmly, telling her that it is sleeping time. As she calms down, walk out. If you think her teeth are the problem, administer whatever pain relief you know work, then leave the room. During the day, let her have quiet time alone in her cot or pram to "rest", even if she is not sleeping.
Remember, teething does not last forever. The good nights will return!
Q: My baby is on her fourth prescription of antibiotics and she is only 9 months old. She is getting repeated ear infections. Giving her medicine ends up in a fight every time and we are both distraught by the end of it! Please help.
A: There could be many causes of your child's ear infections, which makes it difficult for me to comment. However, one common cause of repeat ear infections is prop feeding. This is where your baby is left lying down with the bottle propped up by a pillow.
In this position the milk trickles up the nasal passage and into the Eustachian tube and settles there, causing the infection. So ensure that you and anyone caring for your baby sit her up to feed her. When she is sleeping, place a pillow under the mattress to raise her head slightly; this will let any post-nasal drip drain away from her ears.
Administering medicine to a little one is never easy; she is not well, and on top of that you want to force some awful-tasting liquid down her throat. No wonder she performs!
It is easier to measure the medicine in a sterile syringe or a suction tube medicine dispenser rather than a spoon. Measure the medicine first, tell her that you are "going to give her medicine, which is going to make her better". Talking in soothing tones to her, hold her in your arms and if using the syringe give a little bit at a time towards the back of her month. If you blow in her face she will quickly swallow.
Repeat this process quickly and the dosage will be administered in a couple of minutes.
Q: I am returning to work after three months of breast-feeding my son. Should I continue feeding and having him in bed with us at night - or switch to bottle-feeding and get him to sleep in his cot?
A: Start with the move to bottle-feeding first. It is not unusual for babies to refuse a bottle from mom because they can smell your breast milk just being close to you. Ask dad or the childminder to start the bottle-feeding so that baby can get used to the experience.
It is important that you are not around at the time so that he does not think he can persuade you (by crying) to breast-feed! He will adjust over a few days of consistent bottle-feeds.
In the meantime, it is important that you express milk to keep your supply up if you want to keep feeding after working hours.
Having your baby in bed with you means he is literally "coming between" you and your husband at night. It is a vital process of development for a baby to learn to go to sleep alone - not falling asleep while feeding. Once you establish this during the day it will be easier to implement at night. Place the cot in your room so he is close by. Then you and your husband at least have the privacy of your bed and you can rediscover that you are husband and wife as well as parents!
Q: I need to go back to work and I do not know what is best for my four month old baby. Should I have a childminder at home, or should I send my daughter to daycare? Please advise.
A: It is well documented that an infant who receives love, warmth and consistent care in a one-on-one relationship in her early years is receiving the best start in life. But there are many factors to consider.
First, consider your budget for child care. Then research the costs of the different options. If you can afford to employ a nanny, interview a range of candidates. If not, visit a numbre of day-care facilities to compare standards.
When interviewing a nanny:
Plan a list of all your requirements and questions
Observe while interviewing her:
Is she relaxed or tense?
Is she paying attention to your child?
Is she listening to your questions and answering them appropriately?
Does she appear clean and neat?
Does she speak well?
Does she freely give information about herself, her child care philosophy?
When choosing a child care centre:
Are you made to feel welcome by all the staff?
Is there a happy, relaxed atmosphere?
Is the centre clean, bright, airy?
Is the equipment in a good state of repair?
What is the staff-child ratio?
Are the staff qualified?
Do the staff know the children by name?
Are the children content, stimulated, happy?
Does the centre offer a healthy diet?
Start using the child care service of your choice a few weeks before returning to work to ensure that your baby has settled. This will help you and your baby adjust.
Q: My baby is 9 weeks old and in 3 weeks time I will be leaving her with a day mother when I go back to work. She refuses to take the bottle so I end up giving her the breast again! Can you help?
A: Transitioning your baby off the breast onto the bottle is as much about you as it is about your dauther! She has only known hunger satisfaction through the breast, a skin to skin experience! From her perspective, you are trying to force a foreign rubber object into her mouth with a warm liquid that is unfamiliar. No wonder she is complaining! A key thing to understand is that she can smell breast milk every time you are close by and she will be very upset that you are not giving her what she has become accustomed to! So we need to strategise!
It seems you still want to breast feed her when you can, so ensure that you still give her at least three full breast feeds a day without any bottle. Identify one or two feeds a day when there is another familiar person, eg Dad or Granny, who can give her the bottle. She is not expecting the breast from these people and will be far more likely to adjust to the bottle with them. To refresh her on very hot days you could give her cooled boiled water in a bottle. Persevere and she will adjust.
A reader asks in response to last week's column whether I support the practice of breast feeding, perhaps implying that because my business revolves around providing child care staff I advocate bottle feeding from the start.
A: Having been a child care professional for nearly 30 years I have quite a history to draw on. I am also the mother of four children, including twins - all of whom I breast fed till they were ± 12 months old. Without question I advocate breastfeeding as the best start for newborn and Mom. The exclusive intimate relationship that is built during the first days and weeks as Mom and baby enjoy their regular times of feeding is the source of satisfaction "on tap" and bonding for them. Baby is receiving enough (and the best) nutrition through breast milk until the age of approximately six months, when solids need to be introduced. If Mom has to go back to work she can express breast milk and freeze it (ice cube trays work very well for this purpose) for bottle-feeding purposes during the day. However, the bond between Mom and baby is not dependant on breastfeeding alone, but rather on continuous intimacy, which includes feeding time. Bottle feeding also enables dads to be involved in this special time. Forward-thinking employers who set an office aside for use as a nursery or offer and onsite creche enable Mothers to continue breastfeeding through out the day as required, in addition giving all mothers peace of mind that their babies are close by.
Q: I am about to have my second baby; my firstborn is 13 years old. When she was a baby I was not partcularly bothered about researching what foods to give her and she has a real weight problem now. She is only interested in eating junk food. How can I prevent this becoming an issue with my second child?
A: You are asking a very important question at a very important time - before your second baby is due to start solid food. To provide your baby with the best start, you will need a food blender, fresh vegetables and fruit (organic if possible), and an hour or so each week. When introducing your little one to foods, you will be using a couple of teaspoons each time. So you can freeze the fresh pureed mixes in ice trays and then defrost cubes as required. Wash and peel vegetables and fruit. Pop them in separate pans, bring to the boil and simmer until soft (about 20 minutes, longer for some vegetables). Drain the liquid, reserving it for use in the blender as needed. Mix ingredients in the blender to a soft, mashed banana texture, adding the veggie liquid as necessary. Pour into sterilised ice trays, cover and freeze. Don't add lots of seasoning: use fruit to sweeten the veggie mix. Don't add sugar or fat.
A new book to walk you through the process is Easy Meals for Babies and Toddlers by Deirdre Randall. As for your 13 year old, I would take a more grown-up approach. In school she will be studying nutrition and looking at the relationship between food, a healthy body, and our ability to study, retain information, and so on. Does she participate in sporting activities? She may be quite self-conscious about her eating habits but not know how to change them. This knocks a teenager's self-confidence. Invest some time with a skilled dietician in educating you and your daughter about how best to approach this issue.
Q: My 10 month old son no longer wants to eat baby food. Although his mom breastfeeds him regularly, he doesn't want formula milk. We now give him soft pap and soup. We really don't know what to feed him.
A: Your son is telling you by his actions that he is growing up! Listen to him. Formula milk tastes very different from breast milk; also, he is accustomed to warm soft breast, not the rubberised teat of the bottle. So some things have to change.
Firstly, he is cutting teeth and he needs to learn how to chew. So with every meal give him some finger foods that he can chew on.
Pap is easy for him to eat, but on its own is not going to provide enough nutrition. From about 6 months, infants need a varied diet to gain the nutrients they need to grow into healthy little people.
While Purity and baby cereal have their place in the introduction of solids, it is important to be adding new foods every few days so he does not get bored with a particular taste or texture. He needs to have protein in different forms - lean meat, liver, lentils, fish - as well as wheat products and finger foods, such as slices of fruit, vegetables (cooked and raw), bread, etc.
From nine months he can have cow's milk to mix foods with, but keep giving him formula or breat milk feeds until he is a year old.
He can also have drinks of rooibos tea, water, juice or formula from a cup, which will help make the transition from breast to cup.
By one year, babies should be eating a variety of foods, including milk products, nuts and eggs, but watch out for any allergic reaction. Within reason, your son can have what the rest of the family eat.Babyies who have been allowed to finger theirfoods, to eat by themselves - getting food in their hair and all over their faces and managing to get some of it into their own mouths from an early age - are generally happy to eat a range of foods and have healthy appetities when they are older. So relax; enjoy watching him try new foods, rejoice when he succeeds in feeding himself, and give a helping spoonful here and there.
Q: My granddaughter has been on a soya milk product from birth. She is now eight months old and very overweight. She is also eating solid foods and I wondered if she could cut back on the milk.
She has four 250ml bottles over a 24-hour periodl
A: Soya milk formula is an excellent alternative to breast milk, particularly if there is a history of allergy in the family such as eczema.
Without details about the baby's birth weight and height, it is difficult for me to gauge what "very over weight" would be for her. However, the nursing sister at the well-baby clinic or a paediatrician would certainly be able to ascertain this.
At eight months, milk is still an important part of her diet, but over the next few months, you should lessen the amount of milk she is drinking and increase her solid food. Most babies, when they're getting used to solids, do not eat a wide enough variety of foods to satisfy their growing bodies' nutritional needs. At this stage, your granddaughter's daily intake of formula shyould still be about 750ml (about three bottles) plus cooled boiled water or rooibos tea (weak black tea, unsweetened) when she is thirsty. Avoid juice, which doesn't offer nearly the same nutritional value as formula.
Often babies appear to be quite plump before they begin to crawl. She should have lots of play-time on the floor, preferably on her tummy, which will strengthen her muscles in preparation for crawling and, in time, walking. This will help her trim down.
Q: My son is six months old and I have just started him on solids but he is suffering from constipation. Is there anything I can give him?
A: It is important to properly diagnose his problem as consitpation, as opposed to a change of bowel movement typical of a changing baby diet. An infant having two or three small hard stools a day would be constipation, while another having one normally formed stool on alternate days would not be constipated.
A baby straining to pass a stool is not necessarily a sign of constipation but rather anal fissures. This needs to be treated with a Vaseline-based ointment to allow the skin to heal so that stools can be passed without pain. Also, intestinal muscles are under-developed at this stage and can cause the discomfort we confuse with signs of constipation.
It is important to introduce new solid foods slowly over a number of weeks so that his body can adjust to absorbing the nutrients. Offer pureed fruits and vegetables rather than large quantities of infant cereal. This will help alleviate any tendency towards constipation and broaden his experience of food, a process important for a healthy diet and developing good eating habits.
Constipation can also be caused by dehydration, so ensure - particularly in our hot climate - that he is getting enough fluid by offering a bottle or cup of cooled boiled water.
If constipation continues to be a problem, you could add pureed prunes or prune juice to his solid food. This is known to have the desired effect.
If the problem continues, seek the advice of your baby clinic sister or paediatrician.
Q: I am pregnant with twins and I really want to breast-feed them. They are my first babies. I have no idea how I am going to cope with two.
A: It can seem daunting to be expecting twins, but fortunately, we are created to be able to raise at least two at a time, with two arms to hold them and two breasts to feed them.
It is important to be well informed about how breast-feeding works, from the physiological and emotional points of view. There are many books and websites that can give you a wealth of information and if you are attending antenantal classes, they will include some information about it too.
If you are planning to have your babies in a hospital or a clinic, inform the midwives on the post-natal ward that you want to breast feed and that under no circumstances are your babies to be given formula. Arrange for a nurse to assist in the ward.
Some hospitals have midwives who are trained as breast-feeding counselors. They will assist you in the early days of feeding.
Alternatively, La Leche League offers "mother to mother" support. Contact it ahead of time so that you have someone to guide you through the early days.
Remember, you are not the only parent to have twins. Samba (the South African Multiple Birth Association) is a good organisation to join. It is run "by parents of multiples for parents of multiples" and is a wonderful source of support and information on all aspects of parenting twins, including having experienced breast-feeding moms to talk to.
Q: My baby is four and a half months old. He has been sleeping through from about 11pm to about 5.30am for at least a month. It has been blissful! However, in the past week, he has been waking every two to three hours screaming.
The only thing that settles him is a feed, but it seems he just cannot get enough milk! Can I start him on solids?
A: Your baby certainly is giving all the signs of being ready to start solid food. However, at about that age, babies are often teething. So, before introducing solids, observe his behaviour. The fact that he was sleeping so well but is now consistently waking through the night could be the result of either hunger or pain.
If he is being breastfed, then the only way he can stimulate your breasts to make more milk is to feed more frequently. After a couple of nights, he should settle down again. If he is being bottle fed, then seek the guidance of the nursing sister at your well-baby clinic about increasing his daily intake of milk rather than introducing solids while he is still so young.
A baby's digestive system can cope with a variety of foods only at a bout six months of age, so it is critical that you start him with very bland foods such as rice cereal and/or the puree of a single fruit, such as apple or pear. Avoid dairy products, complex fats and proteins at this stage. Over the weeks, you can add volume as well as a variety of food to his diet. This way, you pave the way for him to enjoy a varied diet and not become a fussy eater. As you will spoon feed him in the early weeks, give him finger foods that he can hold and gnaw on such as a carrot or celery stick. It trains him for the future, when he will be able to feed himself.
