Feeding your baby 2 and young child This chapter provides advice on feeding your baby and young child, from the early days through weaning on solid food and beyond.

Feeding your baby and the longer you breastfeed, is breastfed. Breastfeeding the longer the protection lasts. It reduces the risk of sudden infant Breastfeeding is the healthiest reduces your chance of getting death (also known as cot death). way to feed your baby. Exclusive some illnesses later in life. breastfeeding (that means Formula milk cannot give your Breastfeeding also helps giving your baby breastmilk only, baby the same ingredients or protect against childhood with no other food or drink) is provide the same protection. obesity and diabetes. recommended for around the first six months of your baby’s Breastfeeding helps build a life. Breastmilk provides all the Help with strong bond between mother nutrients your baby needs and breastfeeding and baby, both physically and helps to protect them from emotionally. Midwives, health visitors and infections and diseases. trained volunteers such as peer supporters or voluntary After six months giving your Breastfeeding significantly breastfeeding counsellors baby breastmilk alongside solid reduces the chance of your baby can all offer information food will help them continue being admitted into hospital to and practical help with to grow and develop. The be treated for a chest infection breastfeeding. Peer supporters World Health Organization or a gastric intestinal infection. are mothers who have recommends exclusive Ear and kidney infections are breastfed their own babies and breastfeeding for six months, also less likely if your baby have had training to help them and breastfeeding along with support other mothers. Talk to solid foods into the second year your midwife or health visitor of life and beyond. about the help that is available Breastfeeding protects your in your area. baby from infections and diseases. It also offers health For more information benefits for mums. Every day breastfeeding support groups makes a difference to your baby, in your area visit www.breastfedbabies.org

22 Breastfeeding Just like any new skill, breastfeeding takes time and practice to work well. In the first few days, you and your baby will be getting to know each other. Any close contact and holding your baby against your skin can 2 really help with this. Feeding your baby and young child The more time you spend with ‘Liquid gold’: the your baby, the quicker you perfect food for your will learn to understand each newborn other’s signs and signals. The Colostrum is sometimes called next few pages will help you to ‘liquid gold’. This extra-special understand how breastfeeding breastmilk is full of germ- works. And remember, it’s OK to fighting antibodies that will ask for help. help protect your baby against infections that you have had Immediately after your baby The first few days in the past. The first few feeds is born ‘coat’ your baby’s gut to protect Each time your baby feeds, they Every pregnant woman has milk them from germs and reduce are letting your body know how ready for her baby at birth. This the chances of them developing much milk it needs to produce. first milk is called colostrum and allergies as they get older. The amount of milk you make it is sometimes quite yellow in will increase or decrease in line colour. Later on, your breastmilk will with your baby’s needs. Around still contain antibodies, and as days two to four, you may notice It is very concentrated, so your you come across new infections that your breasts become fuller baby only needs a small amount you will have new antibodies and warmer. at each feed, which might in your milk. This means that if be quite frequent. It is full of you get colds or flu while you This is often referred to as your antibodies to boost your baby’s are breastfeeding, your baby milk ‘coming in’. To keep yourself ability to fight off infection. will automatically get some as comfortable as possible, feed immunity from those illnesses. your baby as often as they want. Holding your baby against your Your milk will vary according skin straight after birth will calm to your baby’s needs. It will them, steady their breathing look quite thin compared with and keep them warm. It will also colostrum, but gets creamier as encourage them to breastfeed. the feed goes on. Let your baby Babies are often very alert in decide when they have had the first hour after birth and enough. keen to feed. Your midwife can help you with this.

23 Sometimes, breastmilk may You can learn more about You can try feeding lying leak from your breast. You may breastfeeding from the Public on your side or in a bed or need to wear breast pads and Health Agency booklet Off to chair, supported in an upright to change them frequently. If a good start. Ask your midwife position. This will make it easier you need to quickly stop your for a copy or visit pha.site/good- to hold your baby so their milk flowing you can apply some start neck, shoulders and back are pressure to your nipple with supported and they can reach the flat of your hand for a few First steps: starting to your breast easily. Their head seconds. breastfeed and body should be in a straight You might like to watch the line. In the beginning, it can seem Bump to Breastfeeding video as that you are doing nothing but you read this part of the chapter Attaching your baby feeding, but gradually your baby so you can see what to expect. To begin breastfeeding, hold will get into a pattern of feeding To view this video visit pha.site/ your baby close to you with their and the amount of milk you bump-to-breastfeeding nose level with your nipple. produce will settle. Getting comfortable Let their head tilt a little so the Your baby will be happier if you top lip can brush against your keep them near you and feed You can breastfeed in a number of different positions. Finding nipple. This should encourage them whenever they are hungry. your baby to open their mouth. This will quickly help your body one that is comfortable for both to produce the amount of milk of you will help your baby feed as well as possible. Once the baby’s mouth is wide your baby needs. At night, your open, bring them to your breast, baby will be safest sleeping in If you are lying back in a well- chin first, head tipped up and a cot in the same room as you. nose clear of the breast. Make This will make feeding easier supported position with your baby lying on your tummy, they sure your baby takes in a large and will reduce the risk of mouthful of breast, not just the sudden infant death. Try to take will often move themselves onto your breast and begin to feed. nipple. Your nipple should go each day as it comes. If you are towards the roof of your baby’s very uncomfortable or sore, ask mouth. for help as soon as possible. Remember at all times to keep your baby safe. Never The let-down reflex Health professionals breastfeed your baby lying down recommend that babies and on a sofa. Your baby’s sucking causes milk adults should be given extra stored in your breasts to be vitamin D. It is recommended Helpful tips squeezed down ducts inside your breasts towards your nipples. that babies who are consuming Breastfeeding should feel less than 500ml of infant comfortable. Your baby should This is called the ‘let-down’ formula a day are given a be relaxed. You should hear reflex. Some women get a supplement of 8.5–10mcg of a soft swallowing. If it doesn’t tingling feeling which can be vitamin D. If you are not eligible feel right, start again. Slide quite strong, while others feel for Healthy Start vitamins, you one of your fingers into your nothing at all. You will see your can buy vitamin D infant drops baby’s mouth, gently break baby respond and their quick from your local pharmacy. the suction and try again.

24 sucks change to deep rhythmic baby crying or when you have a swallows as the milk begins warm bath. to flow. Babies often pause after the initial quick sucks If you have any concerns about while they wait for more milk any of these points, talk to your to be ‘delivered’. If your baby midwife, health visitor or peer falls asleep quickly before the supporter. deep swallowing stage, check that they are properly latched Note that if your baby seems 2 on. It might be easier to get unusually sleepy and/or is slow someone else to check for you. to start feeding, they may be ill, Feeding your baby and young child Sometimes you will notice your so contact your GP as soon as milk flowing in response to your possible.

How do I know that my baby is feeding well?

• Your baby has a large 1 2 mouthful of breast. Bring your baby in close to your Check his head and body • Your baby’s chin is firmly body so that he doesn’t have are in a straight line facing touching your breast. to stretch to reach your beast. the same way as he will be Support his neck, shoulders uncomfortable if he is twisted • It doesn’t hurt you to feed and back. Make sure his head when feeding. Move your baby (although the first few sucks is free to be able to tilt back. so that he starts the feed with may feel strong). his nose pointing to your nipple. • If you can see the dark skin around your nipple, you should see more dark skin above your baby’s top lip than below their bottom lip.

• Your baby’s cheeks stay 3 4 rounded during sucking. Starting ‘nose to nipple’ like With the chin firmly touching, and • Your baby rhythmically takes this allows him to reach up and with the nose clear, the mouth long sucks and swallows get a mouthful of breast from is wide open, and there will be (it’s normal for your baby to underneath your nipple. much more of the darker skin pause from time to time). visible above your baby’s top lip than below their bottom lip – and • Your baby finishes the feed their cheeks will look full and and comes off the breast on rounded as your baby feeds. their own.

25 Tips for breastfeeding • Breastfeeding can be a • Try not to give your baby any • Make sure your baby is well nice chance to sit down and other food or drink before the attached to your breast (see rest. It can soothe, comfort age of about six months. This pictures on page 25). This and calm both you and your will reduce your milk supply will help your body make the baby. and could increase the chance right amount of milk and stop of your baby getting ill. your breasts getting sore. The more you breastfeed How do I know my baby is getting enough milk? your baby, the more milk • Your baby should be healthy and gaining weight. you will produce. When your baby comes off the first • In the first 48 hours, your baby is likely to have only two or breast, offer the second. It three wet nappies. Wet nappies should then start to become doesn’t matter if they are more frequent, with at least six every 24 hours from day five not interested or don’t feed onwards. for long, or even if they feed • Most babies lose weight initially. They should be weighed by a for longer on the second health professional sometime around day three to five. From breast. This is fine – just start then on, they should start to gain weight. Most babies regain with this breast next time. their birth weight in the first two weeks. Sometimes your baby might seem hungrier than usual • At the beginning, your baby will pass a black tar-like stool and feed for longer or more (poo) called meconium. By day three, this should be changing often. Your body responds to a lighter, runnier, greenish stool that is Colour automatically and makes easier to clean up. From day four and for guide for a more milk to provide the extra the first few weeks, your baby should pass baby’s needed. This is why you can at least two yellow stools every day. These stools for feed more than one baby at stools should be at least the size of a £2 coin. the first few days the same time (see page 27). Remember, it’s normal for breastfed babies to pass loose stools. • There is no need to offer Day 1 formula milk in addition to • Your breasts and nipples should not be sore. If breastmilk. If your baby feels they are, do ask for help. hungrier, feed more often, • You can look at the feeding checklist in Off to rather than offer formula milk. Days 2–3 a good start if you think your baby isn’t getting • Breastfeeding mums are enough milk. now encouraged to practice responsive feeding. This • Your baby will be content and satisfied after Day 4 means offering feeds before most feeds and will come off the breast on crying starts (such as when their own. your baby is restless or sucking her fingers). It also If you are concerned about any of these points, involves offering the breast speak to your midwife or health visitor. After four for food and comfort, which weeks or so some breastfed babies will only poo helps maintain a good supply. once every few days and some will occasionally only poo once a week.

26 • Try not to give your baby a dummy until breastfeeding is going well, as this can also reduce your milk supply.

• If you decide to give formula, keep your milk supply going by breastfeeding as much as possible. 2

Breastfeeding while out and Visit www.breastfedbabies.org to born prematurely and to have Feeding your baby and young child about see where your local members a low birth weight, breastmilk When you are out and about, are. is especially important for their wear something that will make wellbeing. To start with, you may it easier for you to breastfeed, Dummies find it easier to feed each of like a t-shirt or vest top and a Try not to give your baby a your babies separately, until you cardigan so that you can lift your dummy until breastfeeding is feel confident about handling top up from the waist to feed. If established, usually when your them at the same time and you are worried about showing baby is a about month old. feeding is well established. your tummy you can wear a belly Using dummies has been shown band or a second vest. to reduce the amount of milk This may take some time, so it that is produced. If your baby can be really helpful to accept The Public Health Agency becomes accustomed to using a any offers of help around the Breastfeeding Welcome Here dummy while sleeping, it should house from family and friends. scheme helps support mums not be stopped suddenly in the who are breastfeeding by first six months. But you should Tamba, the Twins and Multiple asking businesses stop using a dummy when your Births Association, provide to display a baby is between six and 12 information and support on sticker which says months old. feeding – for more information breastfeeding visit www.tamba.org.uk mums are particularly welcome Make sure the dummy is – look for a pink and white sterilised and don’t dip it in Over time, you will learn what heart. honey or sugar to make the works best for you and your baby suck it. They will suck it babies. anyway. Using sugar will only encourage a craving for sweet Triplets can be breastfed either things, which are bad for their two together and then one teeth. after, or all three rotated at each feed. Alternatively, you can Breastfeeding more than use a combination of breast one baby and formula, depending on the babies and your milk supply. See Twins, triplets or more can be page 40 for more on combining breastfed. Because multiple breast and formula feeding. babies are more likely to be

27 you still want to give them breastmilk.

If you have to be away from your baby – for example, because your baby is ill or premature, or because you are going back to work – you may wish to express milk so that somebody else can feed your baby. How long should I many feeds they need while you breastfeed? are apart, but it’s often easier to You can express milk by hand or with a breast pump. Different Exclusive breastfeeding (with manage than people think. Your pumps suit different women, so no other food or drink) is peer supporter, midwife, health ask for information to compare recommended for around the visitor or local support group them. A pump needs to be clean first six months of a baby’s can explain the options and talk and sterilised each time it is life. After this, you can carry them through with you. used. on giving your baby breastmilk alongside other foods for as If you stop breastfeeding, it can Expressing by hand long as you and your baby want. be difficult to restart. Giving It is usually more effective to This can be into the second formula milk to a breastfed express milk by hand than to year or beyond. For information baby can reduce your supply of use a pump in the first few about introducing your baby to breastmilk. See page 40 for more days. If you want to collect the solid foods. information on combining the two. milk, you will need a sterilised container. The following Every day you breastfeed makes Breastfeeding can continue with suggestions should help: a difference to you and your minimal planning and a little support for a planned trip (such baby. There is no need to decide 1. Before you start, wash as a friend’s hen weekend, at the beginning how long you your hands thoroughly then business trip) or separation from will breastfeed. Many mothers gently massage your breast your baby. continue to breastfeed if or to stimulate the milk to start when they return to work or flowing. college. Download the Best Beginnings Baby Buddy app at STEP 1 To find out more about www.bestbeginnings.org.uk breastfeeding and returning to work, see the Public Health Expressing milk Agency leaflet Breastfeeding Expressing milk means and returning to work at removing milk from your breast. pha.site/breastfeeding-work You may want to express milk if your breasts are feeling The practicalities will depend on uncomfortably full, or if your 2. If you are going to collect how old your baby is and how baby is not sucking well but the milk, use a sterilised jug or bowl to catch the milk.

28 3. Place your thumb on top of your breast and the rest of your fingers below about 2–3 centimetres from the base of your nipple, with your thumb and fingers in a sort of C-shape.

STEP 3 2

Expressing milk if your baby information. Also see the Feeding your baby and young child is premature or ill section below for guidance on It is important to try to express storing breastmilk. your milk as soon as possible 4. Release the pressure then after your baby is born (ideally Your midwife, health visitor or peer repeat, building up a rhythm. within the first two hours of supporter can give you practical Avoid sliding your fingers over birth). To ensure that you help and answer any questions. the skin. At first, only drops will produce plenty of milk, you will appear, but just keep going as need to express at least eight to Cup feeding it will help build up your supply. ten times in 24 hours, including Sometimes, your baby might With practice, and a little time, during the night, just as your need some extra milk, or find it milk will flow freely. baby might be doing if they were hard to feed from your breast. STEP 4 able to feed directly. Ask the In this case, your midwife might hospital staff about having skin- suggest that you give your baby to-skin contact with your baby. some expressed milk in a cup. This will help with bonding and Ask her to show you how. In this keeping up your milk supply. way, your baby is able to taste and begin drinking your milk. 5. When no more drops are Hospitals often have machines You should not pour milk directly coming, move your fingers for expressing milk, and will into your baby’s mouth. round to try a different section show you how to use one. If you of your breast and repeat. go home from hospital before Storing breastmilk your baby you may need to use You can store breastmilk for up 6. When the flow slows down, an electric breast pump for to five days in the fridge at 4ºC swap to the other breast. many weeks. You can borrow a or lower. This means putting Keep changing breasts until breast pump from Tiny Life, the the milk in the coolest part of the milk is dripping very premature baby charity. Contact slowly or stops altogether. them on 028 9081 5050 or visit tinylife.org.uk 7. If the milk doesn’t flow, try moving your fingers slightly If you are freezing breastmilk towards the nipple or further because your baby is premature away, and try giving your or ill, ask the staff caring for breast a gentle massage. your baby for support and

29 the fridge, usually at the back Some common Sore or cracked nipples (do not keep it in the door). breastfeeding problems and If your nipples hurt, take your Breastmilk can be frozen in a how to solve them baby off the breast and start domestic freezer for up to three Tender breasts, blocked ducts again. If the pain continues months. and mastitis or your nipples start to crack Milk can build up in the ducts for or bleed, ask for help so you Breastmilk must always be a variety of reasons. The most get your baby latched on stored in a sterilised container. If common are wearing a too- comfortably. you use a pump, make sure you tight bra, missing a feed, or a wash it thoroughly after use and blow to the breast. It’s important It can sometimes take a little sterilise it before use. that you deal with a blocked while to sort out how to prevent duct as soon as possible so the soreness, but it is important to Milk should be defrosted in the that it doesn’t lead to mastitis get support as soon as possible. fridge. Once it’s defrosted, you (inflammation of the breast). will need to use it straight away. The following suggestions may If you have mastitis, your breasts also help: Milk that has been frozen is still will feel hot and tender. You may good for your baby and better • try squeezing out a drop or see a red patch of skin which two of your milk at the end than formula milk. Milk should is painful to touch. You can feel not be refrozen once thawed. of a feed and gently rubbing quite ill, as if you have flu, and it into your skin; Don’t use a microwave oven you may have a temperature. to warm or defrost breastmilk This can happen very suddenly. • let your nipples dry before as this can alter the proteins in It is very important to carry on covering them; your milk and there is a risk of breastfeeding as this will help scalding. you get better more quickly. • if you are using breast pads,

Helpful tips with mastitis • while your baby is feeding, gently stroke the lumpy area with your fingertips towards your If you think you might have mastitis (or a nipple - this should help the milk to flow; blocked duct), try the following: • get lots of rest - go to bed if you can; • take extra care to make sure your baby is attached well to your breast; • take a painkiller such as paracetamol or ibuprofen; • feed your baby more often; • ask for help with how you get your baby • let your baby feed on the tender breast first; latched on properly (see page 25 for • if your breasts still feel full after a feed, or information); your baby cannot feed, express your milk • mastitis may also be a sign of infection. If (see page 28 for more information on how there is no improvement within 12 to 24 to do this); hours, or you start to feel worse, contact • warmth on your breast before a feed can your GP or healthcare professional. help milk flow and make you feel more comfortable; If necessary, they can prescribe antibiotics that are safe to take while breastfeeding.

30 for help to check that your baby is latched on properly, and make an appointment with your GP. You can obtain more information on breastfeeding and thrush from www.breastfeedingnetwork.org.uk

You and your baby will both need treatment. You can easily 2 give thrush to each other, so if your baby has it in their mouth Feeding your baby and young child they will need oral gel and you will still need some cream for your nipples to stop it spreading to you. You may want to ask your pharmacist for advice. they need to be changed nipple) to help it heal and Some antifungal creams can be at each feed (if possible, prevent a scab forming. bought over the counter from a use pads without a plastic pharmacy. backing); It can be hard to ask for help, but tackling any problems as Tongue-tie • avoid soap as it dries your soon as they start will give Some babies are born with a skin out; you more time to enjoy these tight piece of skin between the early days. In lots of cases, • wear a cotton bra, so air can underside of their tongue and the solution is as simple as circulate; the floor of their mouth. This is changing your baby’s position known as tongue-tie, and it can • some mothers treat any slightly or feeding them a bit sometimes affect feeding by cracks or bleeding with a more often. making it hard for your baby to thin smear of white soft attach to your breast. Tongue-tie paraffin or purified lanolin. Unsettled feeding does not always need surgical Put the ointment on the If your baby is unsettled at treatment.. But if after getting crack (rather than the whole the breast and doesn’t seem help with positioning and satisfied by feeds, it may be that attachment it is still difficult to they are sucking on the nipple achieve pain free breastfeeding, alone, and so are not getting it could be helpful to be enough milk. Ask for help to get assessed to see if getting the your baby into a better feeding tongue-tie snipped would help. position. If you have any concerns talk to your midwife or health visitor Thrush and if necessary ask to be seen If you suddenly get sore, bright by a breastfeeding specialist pink nipples after you have within your Health and Social been feeding without problems Care Trust. for a while, you might have an infection known as thrush. Ask

31 Staying healthy You don’t need to eat anything special while you are breastfeeding, just make sure you have a varied and balanced diet.

Your milk is good for your baby rice and potatoes; Helpful tips whatever you eat, but there are foods to avoid (see page 33). • plenty of fibre, found in • Eat when you feel hungry, Being a new mother is hard wholegrain bread and and choose healthy snacks. breakfast cereals, pasta, rice, work though, so it’s important to • You will probably feel pulses (such as beans and look after yourself and try to eat quite thirsty. Have a drink lentils), fruit and vegetables; as varied and balanced a diet as beside you before you sit after childbirth, some women you normally would. Aim to eat down to breastfeed. healthily as a family. A healthy experience bowel problems range of food includes: and constipation – fibre • Try to eat a wide variety helps with both of these; of foods. • at least five portions • Try not to restrict your of a variety of fruit and • protein, such as lean meat diet unless you think a vegetables a day (including and poultry, fish, eggs and food is upsetting your fresh, frozen, tinned, dried pulses; baby. Always talk to your and juiced); • at least two portions of fish health visitor or doctor • a low alcohol intake as each week, including one before cutting out foods. alcohol in breastmilk can portion of oily fish; affect your baby’s feeding • dairy foods, such as milk, Healthy snack ideas or sleeping; avoid drinking cheese and yogurt, which The following snacks are quick alcohol shortly before contain calcium and are a and simple to make and will give feeding your baby; useful source of protein. you the energy and strength you • not too much strong tea or need: coffee; It’s also important to drink plenty of fluid. Aim for at least 1.2 litres • Fresh fruit. (six to eight glasses) each day. It’s a good idea to have a drink beside you when you settle down to breastfeed. All non- achoholic drinks count towards your fluid intake, but milk and water are your best choices. • Sandwiches or pitta bread filled with salad vegetables, To find out more about grated cheese, salmon or • starchy foods such as healthy eating, go to sardine or cold meat. wholemeal bread, pasta, pha.site/healthy-eating • Yogurt and fromage frais.

32 • Hummus and bread or from certain foods, but health drops for your child and these vegetable sticks. professionals recommend that contain vitamin D. If you are not everyone aged five years and getting Healthy Start vouchers • Ready-to-eat dried apricots, over should consider taking a you can ask your local pharmacist figs or prunes. vitamin D supplement during the about buying a suitable vitamin D • Vegetable and bean soups. winter months (October to late supplement for your baby. March/April). You can find out more about • Fortified unsweetened vitamin D from the PHA leaflet at breakfast cereals, muesli Breastfed babies from birth pha.site/vitamin-d-and-you 2 or other wholegrain cereals to one year of age should be with milk. given a daily supplement of Foods to avoid Feeding your baby and young child 8.5–10 micrograms of vitamin D Don’t eat shark, marlin and • Milky drinks or unsweetened throughout the year to make sure fruit juice. swordfish, and limit the amount they get enough, as their bones of tuna you eat to no more • Baked beans on toast or are growing and developing very than two tuna steaks a week baked potato. rapidly in these early years. (about 140g cooked or 170g raw each) or four medium-sized Vitamin D Babies fed infant formula cans of tuna a week (about will only need a vitamin D 140g when drained). These Vitamin D is an essential vitamin supplement if they are receiving for everyone, to help develop types of fish contain high levels less than 500ml (about a pint) of mercury. Don’t eat more than and maintain healthy bones, of infant formula a day, because teeth and muscles. two portions of oily fish per infant formula has vitamin D week. Oily fish includes salmon, added during processing. Babies and young children who mackerel, sardines and trout. Fresh tuna was classified as an don’t get enough vitamin D Children aged 1 to 4 years before they are born or in their oily fish until recently. Recent require a daily supplement of studies have shown the fish oil early lives, can be at risk of vitamin D throughout the year. developing rickets, which causes content of fresh tuna is similar to that of white fish. weak and badly formed bones. If you are eligible for Healthy We get vitamin D mainly from Start you can obtain free vitamin sunlight and a small amount Small amounts of whatever you are eating and drinking can pass to your baby through your breastmilk, so it’s a good idea to think about how much alcohol and caffeine you are having. These may affect your baby in the same way they affect you. If you think a food or foods that you are eating are affecting your baby, talk to your GP or health visitor, or contact the National Breastfeeding Helpline on 0300 100 0212.

33 Alcohol amount of alcohol your baby If it’s a special occasion and Generally, adult women should gets through your breastmilk. you know you are going to be not regularly drink more than It is not safe to get drunk when drinking, consider expressing two to three units of alcohol per you are caring for your baby milk in advance. day. During pregnancy, women – whether they are breast or are advised to avoid drinking. If formula fed. To reduce the exposure of your they do drink, they are advised baby to alcohol: One unit of alcohol is to drink no more than one to • avoid breastfeeding for at two units once or twice a week, approximately equal to a 25ml measure of spirits, half a pint of least two to three hours and are advised not to get after drinking; drunk. beer, or half a 175ml glass of wine, although it depends on the • have your drink after the last When you breastfeed, you strength of the drink. feed of the day – if you can are giving your baby the predict when that will be! best possible start in life. It’s The website pha.site/alcohol- very unlikely that having an units contains more information Caffeine occasional drink will harm you or on units, including the units found in typical drinks. Caffeine occurs naturally in lots your baby. However, we do know of foods and drinks, including that alcohol passes through to If you drink alcohol and coffee, tea and chocolate. the baby in very small amounts. It’s also added to some soft So when breastfeeding it is breastfeed, it can affect your baby in a number of ways: drinks and energy drinks and sensible to drink no more than to some cold and flu remedies. one or two units once or twice a • your milk may smell different In the early days, it is important week. and put your baby off that you don’t have too much feeding; caffeine. Try decaffeinated tea If you have drunk more than and coffee, fruit juice or mineral one or two units, it is worth • the alcohol may make your water and limit the number of remembering that the level baby too sleepy to feed; energy drinks, which might be of alcohol in your breastmilk high in caffeine. reduces in the same way as it • your baby may have does in your body – so waiting difficulties with digestion an hour or more will reduce the and problems with their sleeping patterns.

34 Smoking You can also speak to your GP chance of the baby developing Smoking is bad for you, bad for or pharmacist about the nicotine a peanut allergy. But this advice your partner and especially bad replacement therapy available to has been changed because the for your baby. One of the best help you manage your cravings latest research shows that there things you can do for your own and become smoke free. is no longer clear evidence to and your baby’s health is to stop say that eating or not eating smoking. Peanuts peanuts while breastfeeding Peanuts are one of the most has any effect on your baby’s Each year, more than 17,000 common causes of food allergy chances of developing a peanut 2 children under the age of (see page 67). Peanut allergy allergy. Feeding your baby and young child five are admitted to hospital affects about 1% of people and because of the effects of can cause severe reactions. second-hand smoke. Your baby may be at higher risk of developing a peanut allergy if Avoid smoking in the home you, the baby’s father, brothers or car, and ask your partner, or sisters have a food allergy friends and family to do the or other allergic condition such same when they are around as hayfever, asthma and/or your baby. eczema.

If you do smoke and you If you would like to eat peanuts are finding it difficult to quit, or foods containing peanuts breastfeeding will still protect (such as peanut butter) while your baby from infections and breastfeeding, you can choose give them nutrients they cannot to do so as part of a healthy get through formula milk. balanced diet, unless you are Smoking after feeds, rather than allergic to them or your health before, will help reduce your professional advises you not to. baby’s exposure to nicotine. You may have heard that some women have, in the past, If you have a child under chosen not to eat peanuts while six months and are not they were breastfeeding. This breastfeeding (for example is because the government because you are feeding your previously advised women baby on formula), then there is that they may wish to avoid no reason why you should avoid eating peanuts while they were consuming peanuts or foods breastfeeding if there was a containing peanuts. history of allergy in their child’s immediate family (such as You are up to four times If you have any questions or asthma, eczema, hayfever, food concerns, you should discuss more likely to stop smoking allergy or other types of allergy), successfully with support. Visit these with your GP, midwife, in case small amounts of peanut health visitor or other health www.stopsmokingni.info for in their breastmilk increased the further information. professional.

35 Medicines and • common painkillers such as pharmacist. Some cold remedies breastfeeding paracetamol and ibuprofen are not suitable. (but not aspirin); Many illnesses, including It’s fine to have dental depression (see page 18), • hayfever medicines such as treatments, local anaesthetics, can be treated while you are Clarityn and Zirtek; injections (including mumps, breastfeeding without harming measles and rubella (MMR), your baby. Small amounts of • cough medicines (provided tetanus and flu injections) and whatever medicines you take they don’t make you most types of operations. You will pass through your breastmilk drowsy); can also dye, perm or straighten to your baby, so always tell your • asthma inhalers; your hair, use fake tan and wear doctor, dentist or pharmacist that false nails. you are breastfeeding. • normal doses of vitamins. Illegal drugs are dangerous Medicines that can be taken You can use some methods for your baby, so talk to your while breastfeeding include: of contraception but not all, midwife, health visitor, GP or for so check with your GP or • most antibiotics; Medicines for minor ailments when breastfeeding • Make sure the medicine is safe to take when breastfeeding. • Watch your baby for side effects such as poor feeding, drowsiness and irritability. Stop taking the medicine if your baby gets side effects. • For further information speak to your pharmacist.

Minor ailment First choice Second choice Do not use

Constipation Eat more fibre Bisacodyl Bulk laxatives that contain ispaghula Senna Lactulose Cough Honey and lemon in hot water Medicines that contain Simple linctus codeine (co-codamol, co- dydramol) or guaifenesin Diarrhoea Oral rehydration sachets Occasional doses of loperamide Haemorrhoids (piles) Soothing creams, ointments or suppositories Ice pack Hayfever, house Antihistamine eye drops or nasal sprays Antihistamines – cetirizine Other antihistamines unless dust mite and Steroid nasal sprays or loratadine advised by your doctor animal hair allergy Head lice Wet combing If ineffective, then head lice Dimeticone lotion lotions that contain permethrin Indigestion Antacids (indigestion mixtures) On your doctor’s advice: medicines that reduce acid production, for example omeprazole Nasal congestion Steam inhalation Oxymetazoline or Medicines that contain (stuffy or xylometazoline nasal sprays phenylephrine runny nose) Occasional doses of pseudoephedrine Pain Paracetamol Ibuprofen Medicines that contain aspirin (headache, mastitis, Medicines that contain codeine toothache) (co-codamol, co-dydramol), unless advised by your doctor Threadworms Mebendazole Vaginal thrush Clotrimazole pessaries or cream Fluconazole

36 more information go to pha.site/ drugs-in-breastmilk, or call the Drugs in Breastmilk Helpline on 0844 412 4665.

Your GP or pharmacist may like to look at the information from the National Formulary for Children (bnfc.nice.org.uk) to see 2 what medicines can be given to babies and children, as these are How fathers and partners between expressing or Feeding your baby and young child likely to be safe for mothers to can help feeds may lower milk supply. take when breastfeeding. After the first few weeks when breastfeeding is going well, you Knowing what helps What dads should know might decide to express some There are very few women who about breastfeeding milk so someone else can help cannot breastfeed for medical The father or partner’s support with an occasional feed. reasons. However, many women is vital to helping you continue experience difficulties if the to breastfeed, as they can help Expressing milk can be done by baby is not latched onto the by: hand or, more usually, by using a breast properly. pump to collect milk from • making sure mother and the breast and store it in a The more often your baby baby are comfortable while bottle. Your health visitor or breastfeeds the more milk will be feeding; community midwife will be able made – it works on supply and to give advice on this. See also demand. Most babies will want to • explaining to family and www.breastfedbabies.org feed frequently, especially in the friends about the importance first weeks, so some feeds will of breastfeeding; It’s important to remember: seem very close together. • bringing you a drink or a • Breastfeeding must be healthy snack to eat, such You and your well established before a as a piece of fruit or a slice partner may bottle is introduced as some of toast; worry that babies can get confused your baby • preparing meals and doing or develop a preference for is not the housework so you can the bottle. This is because getting concentrate on feeding your the sucking action required enough baby; to feed from a bottle is milk because different to that used to feed you can’t • encouraging you, particularly from the breast. measure when you are very tired or the finding things difficult; • Maintaining a good milk supply depends on milk amount • protecting you from others’ being removed regularly they opinions about breastfeeding either by breastfeeding or get. which may be undermining. expressing. Long periods But if they are having wet and How dads and partners can dirty nappies and gaining weight get involved at a normal rate, that means If your baby is breastfed it is they are getting enough. important for mum to feed baby initially, but dads and partners In fact, as your baby gets both a can be involved in many other drink and food from the breast, ways caring for and being close there is no need for anything to the baby. Here are some else for the first six months. suggestions that might be useful to new parents: You and your partner may energy to make love, but it is feel self-conscious about • change your baby’s nappy; possible for you both to enjoy breastfeeding in public but it an active sex life. can be done without anyone • settle your baby after a feed noticing. Your partner can lift her by winding them; It is a good idea for mum to top from the waist and perhaps • hold and soothe your baby; feed the baby first so that she is use a blanket, scarf or shawl. It more comfortable and your baby can look as if your baby is just • play with your baby; is settled and you are less likely having a cuddle. • place your baby on your to be disturbed by him crying. Breastfeeding is sometimes bare chest for skin-to-skin Remember that breastfeeding used as a method of contact; may make your partner’s breasts contraception. If you definitely • give your baby a massage; feel more sensitive. don’t want to have another baby just yet, it is best to use • carry your baby in a sling or Some men really like the other more reliable methods of baby carrier; changes in their partner’s contraception which are suitable breasts during breastfeeding while breastfeeding. • talk, read and sing to your baby; whereas others may be concerned that breastfeeding Keeping mother and baby • take your baby for a walk in makes breasts less attractive, together at night is important the pram; but there is no evidence that as it makes it easier for mum to any breast changes due to feed baby in a responsive way. • bath your baby. breastfeeding are permanent.

Breastfeeding is handier than Your relationship with your You and your baby bottlefeeding at night and when partner away from home as there’s no The more you get involved need to worry about keeping Some parents worry that with caring for your baby, the milk fresh and heating bottles, breastfeeding will affect the more quickly you will develop plus it’s free – bottlefeeding a physical side of their relationship a strong bond. Try to enjoy this baby can cost over £800 a year. with their partner. Some women time – it is busy and tiring but Your partner will lose weight lose interest in sex after having the rewards are amazing and it more quickly after the birth if a baby and for most couples it is won’t last forever! she breastfeeds. difficult to find the time and

38 Breastfeeding help and support Don’t be afraid to ask for the support and information you need to make breastfeeding work for you and your baby. No problem is too small – if something is worrying you, the 2 chances are that other mothers

will have felt the same. Feeding your baby and young child or health visitor, or contact the NCT (formerly the National Breastfeeding National Childbirth Trust) You can get help from a Helpline on 0300 100 0212 Breastfeeding Line peer supporter, your midwife (lines are open from 9.30am to 0300 330 0771 or health visitor. You might 9.30pm) or go to the website www.nct.org.uk also want to join a local at www.nationalbreastfeeding breastfeeding group. It’s a great helpline.org.uk The Unicef Baby Friendly site way of making new friends as at www.unicef.org.uk provides well as sharing the ups and You can also get information information and links to useful downs of looking after a new online from the Association resources about many aspects baby. Most groups usually of Breastfeeding Mothers of breastfeeding. include a mix of healthcare (www.abm.me.uk) and the professionals and local trained Breastfeeding Network (www. The Breastfeeding volunteer mothers (peer breastfeedingnetwork.org.uk). Network’s Drugs in supporters). These mothers The Breastfeeding Network runs Breastmilk Helpline can have breastfed their own babies a Support line on 0300 100 provide information about and have had some training in 0210, and also offers a helpline breastfeeding and medicines. basic breastfeeding techniques. for speakers of Bengali/Sylheti Call 0844 412 4665. Some peer supporters will have on 0300 456 2421. Lines are had more in-depth training to open from 9.30am to 9.30pm. All these voluntary organisations help them support new mothers. provide training for peer For breastfeeding information supporters. There may be specialist drop-ins visit the Public Health Agency in your area where you can go if website www.breastfedbabies.org The Bump to Breastfeeding you have a specific concern or (Best Beginnings) video is a difficulty. The following voluntary useful source of information organisations can also provide and will give you an insight into A list of breastfeeding groups for information: other mothers’ experiences of Northern Ireland can be found breastfeeding. You can view this on www.breastfedbabies.org or La Leche League video online at pha.site/bump- ask your midwife or health visitor 0845 120 2918 to-breastfeeding about your local group. www.laleche.org.uk To find out what is available in your area, talk to your midwife

39 So give yourself plenty of time cuddling your baby in close for the change, and cut out contact (skin-to-skin) as much one feed at a time. Try the first as possible gives you and your formula feed when your baby is baby the time and opportunity happy and relaxed – not when for breastfeeding to happen as they are very hungry. It may help easily as possible. if someone other than you gives the first feeds, so that your baby This stage can take some time, is not near you and smelling with your baby building up feeds your breastmilk. It may take your little and often. This boosts your Different feeding baby a little time to get used to supply. When your baby comes situations the new arrangements. So keep off the first breast, offer the Some mothers breastfeed trying, stay calm and don’t force it. second. It doesn’t matter if they whereas other mothers use are not interested or don’t feed infant formula, and some If you are making these changes for long. This is fine – just start mothers use a combination. because you are going back with that breast next time. Talk There are several different ways to work, make sure you start a to your midwife, health visitor or of doing this: few weeks before you are due peer supporter about ways to to go back. However, don’t feel reduce the amount of formula or • you can express breastmilk you have to stop breastfeeding expressed milk. to be given by bottle; if you are returning to work. Depending on what age your If you have been expressing • you can introduce infant baby is, they may take milk milk for most of your baby’s formula but carry on from a cup while being cared feeds, it is often helpful to carry breastfeeding; for by someone else and you on so you keep your supply high • you can introduce can breastfeed when you are at during this transition period. infant formula and stop home with your baby. breastfeeding; Types of milk to avoid Changing from breast to formula Cows’ milk should not be given • depending on the age of feeding can be an emotional as a main drink to a child under your baby, they may take the time for you. It’s best to do it the age of one year. Small milk in a cup. gradually to give yourself time amounts of cows’ milk can to adapt and your body time to be used in the preparation of Introducing infant formula reduce the amount of milk it foods and for cooking after Introducing infant formula will makes. six months of age. Condensed reduce the amount of breastmilk milk, evaporated milk, dried milk, you produce. This may make Increasing the amount of sheep’s milk, or any other type breastfeeding more difficult. breastmilk you make of drinks (such as rice, oat or If you have had a difficult start almond drinks, often known as Most mothers find it easier, or have changed your mind and ‘milks’) should never be given more comfortable and less want to start breastfeeding, to a baby under the age of one likely to cause mastitis (painful, talk to your midwife, health year. You should not use soya inflamed breasts) if they visitor or peer supporter about formula unless it has been gradually stop breastfeeding. what you can do. Holding and prescribed by your GP.

40 Follow-on formula should never standards for what they contain. be fed to babies under six months More expensive brands still have old and there is no need to switch to meet the same standards to these milks after six months. as cheaper brands. To find out more about infant formula visit Some follow-on formula has www.firststepsnutrition.org cereal added to it, and is described as a ‘night-time feed Infant formula milk usually for babies’. This type of formula comes in powder form and is 2 is not necessary and there is no based on processed, skimmed evidence that babies settle better cows’ milk and is treated so opened, the carton should be Feeding your baby and young child or sleep longer when fed this. babies can digest it. Vegetable stored in the fridge with the cut oils, vitamins, minerals and fatty corner turned down or screw Formula feeding acids are added to make sure cap replaced. Do not store it for longer than 24 hours. You can This new information is the milk contains the vitamins continue giving your baby infant based on guidance from the and minerals that young babies formula when they are older Department of Health and need. This information will be than six months. If you have any the Food Standards Agency. It on the contents list of the pack. worries about the infant formula may differ from what you have Infant formula powders are not milk you are giving your baby, done before if you have older sterile, so it is important to follow ask your midwife, health visitor children, but to minimise any the cleaning and sterilising or GP for information. risk it is recommended that you instructions on page 42. follow this new information. Formula is either ‘whey Using formula milk safely Choosing a formula dominant’ or ‘casein dominant’, Powdered infant formula milk depending on the balance of must be prepared as carefully The different types of infant proteins it contains. It may also as possible. It is not a sterile formula, and other infant milks be referred to as stage one or product, and even though tins marketed for babies and young stage two milk. Whey-dominant and packets of milk powder children, can seem confusing as milk is thought to be easier to are sealed, they can contain there are lots of different brands digest than casein-dominant bacteria such as Cronobacter and types available. The majority milk, so should always be the sakazakii (formerly known as of infants who are formula fed first formula you give your Enterobacter sakazakii) and, or mixed fed should be given baby. There is little nutritional more rarely, salmonella. a first infant milk (sometimes difference in the two forms called first stage or stage 1 of milk, so if whey-dominant If the feed is not prepared milk) throughout the first year. formula milk suits your baby, safely, these bacteria can cause they can stay on it for the first infections. Infections are very All infant formula on the UK year or even longer. rare, but can be life-threatening. market must meet required Formula must therefore be ‘Ready-to-feed’ infant formula made up with water hot enough milk in cartons is also available. to kill the bacteria – at least This is generally more expensive 70ºC. In practice, this means than powdered milk. Once boiling the kettle and leaving

41 it to cool for no longer than 30 given vitamin D supplements equipment in cold, clean minutes. from birth, see page 56 for running water before more information. You can buy sterilising. Vulnerable premature babies suitable drops at any pharmacy. benefit from the use of ready- 2 Cold water sterilising. to-feed formula rather than Ask your midwife or health Follow the manufacturer’s powdered formula to reduce visitor where you can get vitamin instructions. Change the the risk of contamination and drops. sterilising solution every 24 infection in hospital, however hours, and leave feeding on discharge home a powdered Sterilising equipment in the solution for formula can be used. If you are All the equipment used for at least 30 minutes. Make using formula, mix the formula feeding your baby must be sure there is no air trapped and water and cool quickly to sterilised. By sterilising your in the bottles or teats when feeding temperature in cold feeding equipment, washing putting them in the sterilising water. your hands and keeping the solution. Keep all the preparation area clean, you will equipment under the solution It’s also essential to make up a reduce the chance of your baby with a floating cover. fresh bottle for each feed. Throw getting sickness and diarrhoea. away unused formula within two 3 Steam sterilising (electric hours. Bacteria multiply rapidly The following cleaning and or microwave). Follow the at room temperature and can sterilising instructions apply manufacturer’s instructions. even survive and multiply slowly whether you are using Make sure the openings in some fridges, so storing expressed breastmilk or infant of the bottles and teats are formula milk for any length of formula milk. facing down in the steriliser. time increases the risk. Any equipment not used 1 Clean and rinse. Clean the straight away should be Automatic formula bottle and teat in hot soapy re-sterilised before use. makers water as soon as possible Preparing a feed The Food Safety Authority after a feed, using a clean of Ireland (FSAI) does not bottle brush. Rinse all Step 1: Before making up a recommend the use of feed, clean and disinfect the automatic formula preparation surface you are going to use. machines. There is not Wash your hands carefully. enough evidence to support If you are using a cold water the safety of these machines. steriliser, shake off any excess solution from the bottle and the teat or rinse the bottle Vitamin drops with cooled boiled water from If your baby is formula fed, you the kettle (not the tap). Stand should give them vitamin drops the bottle on a clean surface. from the age of six months or Keep the teat and cap on the if they are drinking less than upturned lid of the steriliser. 500ml of formula milk a day. Don’t put them on the work Some babies may need to be surface.

42 STEP 2 Step 3: Loosely fill the scoop Make sure you make up a with milk powder and level it fresh bottle each time you off using the flat edge of a feed your baby and throw away clean, dry knife or the leveller unused feed after two hours. provided. Do not pat it down. Using stored formula milk can increase the chance of your STEP 4 baby becoming ill.

Feeding your baby 2 Always cool your baby’s milk Feeding your baby and young child down before feeding. At 70°C, it is still hot enough to scald. Step 2: Use fresh tap water to To cool it, hold the bottle, with boil a kettle with at least 1 litre the cap covering the teat, under of water. After it has boiled, let cold running water. Test the the water cool for no more than Step 4: Add the milk powder temperature of the feed by 30 minutes. Don’t use artificially to the water. Repeat, until dropping a little onto the inside softened water or water that you have added the number of your wrist. It should just feel has already been boiled. If you of scoops specified in the warm to the touch, not hot. have to use bottled water, you manufacturer’s instructions. It is will still need to boil it. The water important to use only the scoop If the milk is too cool, and your must still be hot, otherwise any that is enclosed with that milk baby doesn’t like it that way, you bacteria in the milk powder powder. Using too much powder can warm it up a little by putting might not be destroyed. For can give your baby constipation the bottle upright in some hot more information on bottled and lead to dehydration; too water, keeping the teat out of water, go to www.eatwell.gov.uk little could mean that your baby the water. Never warm milk is not getting the nutrients in a microwave oven. It will Always put the partially they need. Don’t add sugar or continue to heat up for a time cooled boiled water in the cereals to the feed in the bottle. after you take it out of the bottle first. STEP 5 microwave, even though the Be careful – at 70°C, water is outside of the bottle may feel still hot enough to scald. Always cold. The milk inside may be check that the water level is very hot and could scald your correct. Failure to follow the baby’s mouth. manufacturer’s instructions may make your baby ill. Responsive bottle feeding Get everything you need ready STEP 3 before you start feeding. Find Step 5: Holding the edge of a comfortable position to hold the teat, put it on the bottle. your baby while you are feeding. Screw the retaining ring onto Use this time to connect with the bottle. Cover the teat with a your baby, hold them close, talk cap. Shake the bottle until the to your baby and make eye powder dissolves.

43 contact. Offer the bottle gently When feeding, make sure giving your baby time to take you keep the teat full of milk, breaks. Some babies take some otherwise your baby will take milk, pause for a nap, and then in air and get wind. If the teat wake up for more. So you will becomes flattened while you need to be patient. Remember, are feeding, pull gently on the feeding is an opportunity to corner of your baby’s mouth to feel close to your baby and for release the vacuum. If the teat you and your partner to get gets blocked, replace it with to know them. Avoid lots of another sterile teat. different people feeding your water to make up infant formula baby as this can be confusing (for babies of any age), you At the end of the feed, sit and and frightening for them. Even should boil it and allow it to cool hold your baby upright and when your baby is a little older, for no more than half an hour. gently rub or pat their back for they should never be left alone a while to bring up any wind. to feed with a propped-up bottle, Bottles and teats There is no need to overdo it – as they may choke. You might find it useful to have wind is not as big a problem as about six bottles and teats, so you many people think. can always have at least one or two bottles clean, sterilised and Talk to your baby as you rub ready for use. Ask your midwife or or pat. This will help them feel health visitor for more information. closer to you and get them used to listening to your voice. Don’t You should always buy new forget to throw away any milk teats. They come in different that is not used within two hours. shapes and with different hole sizes, and you may have to try Most babies gradually settle into a Bottled water several before you find the one pattern. Babies vary in how often Bottled water is not a healthier that suits your baby. If the hole they want to feed and how much choice than tap water and usually is too small, your baby will not milk they want to take. Feed is not sterile. In fact, some natural get enough milk. If it’s too big, your baby when they are hungry, mineral waters are not suitable the milk will come too fast. just as you would if you were for babies because of the breastfeeding, and don’t try to amount of minerals they contain. It’s best if you can buy new force your baby to finish a bottle. If you need to use bottled water, bottles too. Check regularly to They may have had enough for remember that any bottled water make sure the bottles are in the time being or just want a rest. that is labelled ‘natural mineral good condition. If they are badly water’ might contain too much scratched, you will not be able to sodium for babies. sterilise them properly. If in doubt, ask your midwife or health visitor If you are giving bottled water for more information. to babies under six months, you should boil and cool it just like tap You should check regularly that water. If you need to use bottled teats are not torn or damaged.

44 Feeding away from home The safest way of feeding your baby away from home is to carry a measured amount of milk powder in a small clean and dry container, a flask of boiled hot water and an empty sterilised feeding bottle. Make up a fresh feed whenever you need it. The 2 water must still be hot when you formula feeds called ‘extensively Babies should be discouraged Feeding your baby and young child use it, otherwise any bacteria in hydrolysed protein feeds’. from holding the teat of a bottle the milk powder might not be in their mouths when they are destroyed. Remember to cool Some formulas are labelled as not drinking. This is because it is the bottle under cold running hypoallergenic, but they are important for learning to eat and water before you use it. not suitable for babies with a talk, and for developing healthy diagnosed cows’ milk allergy. teeth. Alternatively, you could use Talk to your GP before using ready-to-drink infant formula this milk. Always get their advice milk when you are away from before using soya-based infant home. formulas, too. Babies who are allergic to cows’ milk may also If it’s not possible to make up be allergic to soya. a fresh feed, or if you need to transport a feed – for example Babies sometimes grow out of to a nursery or childminder – allergies, and you may find that you should prepare the feed at you can introduce cows’ milk home and cool it in the back of into your baby’s diet as they get the fridge for at least one hour. older. Always ask your GP or Take it out of the fridge just health visitor for advice before Babies can be encouraged to before you leave, and carry it in making any changes to your use cups when they start on a cool bag with an ice pack and baby’s diet. solid food. use it within four hours. If you reach your destination within When to use a cup four hours, take it out of the cool bag and store it at the back While breastfeeding is of a fridge for a maximum of encouraged into the second 24 hours. Re-warm for no more year and beyond, for bottlefed than 15 minutes. babies it is recommended that after one year all drinks should Coping with allergies be given from a cup and a feeding bottle should no longer If you think your baby might be be used. allergic to formula milk, talk to your GP. They can prescribe

45 Some common problems with formula feeding Introducing your baby to Crying and colic solid food For information about crying and colic, see page 83. Food is one of life’s greatest pleasures. Yet it’s also a source Sickness and vomiting of worry for many parents. What Some babies bring up more milk than others during or just should my baby or child be after a feed. This is called ‘possetting’, ‘regurgitation’ or ‘gastric eating? How do I encourage them reflux’. It is not unusual for babies to bring up quite a lot, but it to eat lots of different foods that can be upsetting when it happens and you may be worried that will help to keep them healthy? something is wrong. Can I afford to feed them the right things? The next few As long as your baby is gaining weight, there is usually nothing pages will give you some basic to worry about. But if guidelines on how to introduce your baby is violently your baby to solid foods and sick or appears to be in eating with the rest of the family. pain, or you are worried for any other reason, talk For the first six months, babies to your health visitor or only need breastmilk (or infant G P. formula milk). It’s normal for babies aged three to five months Cover your baby’s front to start waking up in the night. when feeding and have This doesn’t necessarily mean a cloth or paper towels they are hungry. At this age, handy to mop up any their digestive system is still mess. Check that the hole in your baby’s teat is not too big, as developing and they are probably giving milk too quickly can cause sickness. Sitting your baby not ready for solid food. upright in a baby chair after a feed can also help. By about six months, most babies The problem usually stops after six months when your baby is are ready to start on solid food. starting on solid foods and drinking less milk. At this age they may be able to sit up, wanting to chew and If your baby brings up a lot of milk, remember that they are putting toys and other objects in likely to be hungry again quite quickly. Don’t force your baby to their mouths, and reaching and take more milk than they want during a feed. Remember, every grabbing for things. baby is different. Some prefer to feed little and often. Introducing a good variety of Constipation healthy foods from the start Always stick to the recommended amount of infant formula will help lay the foundations for milk powder. Using too much can make your baby constipated healthy growth and development. or thirsty. Breastfed babies don’t usually get constipated. If your baby is under eight weeks old and has not passed a stool Eating with the family and for a few days, talk to your health visitor or GP. For further sharing the same foods will help information, see page 89. your baby learn valuable social skills too.

46 You can learn more about introducing solid foods from the Public Health Agency booklet Weaning made easy, available at pha.site/weaning

When to start solid foods? Health experts agree that about six months is the best age for 2 introducing solids. Before this, Babies who were born eat much salt, so you should Feeding your baby and young child your baby’s digestive system is prematurely may be ready at not add any to your baby’s food. still developing, and introducing different times. Ask your health Encourage babies and young solids too early can increase the visitor for advice on what is best children to feed themselves risk of infections and allergies. for your baby. with finger foods, and let them Research has also shown that decide when they have had introducing solid food has Have your baby eating with enough. virtually no impact on how long the family as early as possible. a baby sleeps. It is also easier to Breastfed babies have been Getting started introduce solids at six months. enjoying the tastes and flavours The idea of introducing solids is of the foods you have been If your baby seems hungrier to introduce your baby gradually eating through your milk. This at any time before six months, to a wide range of different seems to help them to accept offer extra breastfeeds. Many textures and tastes so they can and eat foods more easily as mothers find that as their baby join in family meals. Introducing they get older. grows and gets heavier it can a variety of foods will also help be very useful to make sure the make sure your baby’s diet is Sitting your baby in a high baby’s attachment at the breast nutritionally balanced. chair at the table means that is as good as it can be – this you can smile and talk to them enables the baby to build up Babies often like to start while they eat so that they feel your supply again really quickly by holding foods such as included. Give your baby the so that it is meeting their needs. vegetables cut into sticks or fruit. same food as the rest of the Trying an extra feed for a family, mashed or cut up into formula fed baby can also meet Babies can help themselves to small pieces. Babies should not their needs. mashed foods. Some mothers may spoon-feed their baby but they will soon be able to do it themselves.

Some babies take time to learn to eat new foods. Your baby will be finding out about different tastes and textures and that food doesn’t come in a continuous flow. This may

47 • Feeding your baby is a great opportunity to communicate, so keep talking to them the whole time. This will help them to relax while they are eating. You will usually be sitting facing them, so they can really concentrate on what you are saying. Initially, your sentences can be very take time and you should be • Your baby should be sitting short (‘More?’). As your prepared for some mess! Never up straight and facing the child gets older, you can leave your baby alone when food. This will make it easier start offering more choices eating in case they choke. for them to explore foods and using more complex and they will be less likely to language (‘Do you want milk Solid foods and milk choke. A high chair may be or water?’). You will find that as your baby useful. • Babies love to explore and eats more solid foods, the • Everything you use for do things for themselves amount of milk they want will feeding your baby should – it is how they learn new start to reduce. Once your baby be really clean. It’s better skills – so encourage your is eating solids three times a to spoon out the amount baby by giving finger foods day, you may find that they take you think your baby will eat so that they can do it for less milk at each feed or even and heat this, rather than themselves. Don’t worry if drop a milk feed altogether. heating a large amount that they make a mess. then goes to waste. You can Helpful tips always heat up more if it’s • Never leave your baby These points may help when your needed. Some babies are alone when eating as they baby starts to eat solid foods: happy to eat food that has could choke. For further not been heated. information on choking, see • It needs to be a relaxed time page 155. – not when you are in a hurry • Never reheat food that has or the baby is unsettled. already been reheated to prevent food poisoning. • To eat solid foods your baby has to learn to move • At first your baby will only food from the front of need small amounts to try. their tongue to the back so that they can swallow • Cover the floor with it. Some seem to do this newspaper or a protective really quickly and others mat and use a bib to catch take longer – that is OK, it’s food spills – introducing more important to go at your solids can be a messy baby’s pace. business!

48 How will I know when my • Keep surfaces clean and • Wash and peel fruit and baby has had enough? keep any pets away from vegetables, such as apples Most babies know when they food or surfaces where food and carrots. is prepared. have had enough to eat, so don’t • Teach your children to wash try and persuade your baby to • Keep chopping boards and their hands after touching take more food than they want. utensils thoroughly clean. pets and going to the toilet, Babies are telling you they have and before eating. had enough when they: • Keep cooked and raw meats covered and away from each Don’ts: 2 • turn their head away; other and from other foods • Don’t save and reuse foods Feeding your baby and young child • keep their mouth shut; in the fridge. Always wash your hands after touching that your baby has half • push the bowl or plate away raw meat. eaten. or on to the floor; • Thoroughly wash all bowls • Don’t give your baby • scream or shout; and spoons for feeding in shellfish. hot soapy water. • keep spitting food out; • Don’t give babies food or • When reheating food, make drink when they are sitting • hold food in their mouth and sure it’s piping hot all the on the potty. refuse to swallow it. way through and then let it cool down before giving it to Due to improved food safety It doesn’t really matter how much your child. If you are using controls in recent years it is they eat; the important thing is to a microwave, always stir unlikely to get food poisoning get them trying lots of different and check the temperature from raw or lightly cooked hen things. Give your baby plenty of before feeding it to your eggs from reputable suppliers attention, chat and enjoy meals child. Don’t reheat cooked which have been produced together, and don’t pressure food more than once to under the British Lion Code of them when they refuse food. prevent food poisoning. Practice. Therefore it is safe to enjoy soft boiled eggs and foods Safety and hygiene • Cook all food thoroughly containing raw or lightly cooked Babies and young children are and cool it to a lukewarm eggs. For more information on especially vulnerable to the temperature before giving it to food safety and hygiene, go to bacteria that can cause food your baby. the Food Standards Agency poisoning. Following a few website at www.food.gov.uk simple guidelines will help to protect them from germs.

Dos:

• Always wash your hands

well before preparing food.

• Check that hands are clean before feeding.

49 Storing and reheating food Cool food as quickly as possible (ideally within one to two hours) and put it in the fridge or freezer. Food placed in the fridge should be eaten within two days. Frozen food should be thoroughly defrosted before reheating. The safest way to do this is in the fridge overnight or using the defrost setting on a microwave. Reheat food held in their hand and stick out Giving your baby a varied diet thoroughly so it is piping hot all the top of their fist. Food cut When you are both ready, you the way through, but remember into pieces that are adult finger can start to increase the amount to let it cool down before sized usually works well. Try: of solid food your baby is getting. offering it to your baby. To cool Your baby is the best guide to how food quickly, put it in an airtight • sticks of cooked parsnip, much solid food you need to give. container and hold it under a potato, yam, sweet potato Aim to go from offering solid food cold running tap, stirring the or carrot (or mash them to once a day to providing it at two contents from time to time so begin with); and then three feeds. Offering they cool consistently all the • banana, avocado, cooked different foods at each of the way through. apple, peach, melon or pear; three meals will give your baby more variety and will help them to Choosing foods for your • pieces of raw apple (large get used to different flavours. baby enough for your baby to First foods gnaw on); Your baby’s first solid foods • rice (mashed, puréed or need to be simple foods that baby rice to begin with) and they can easily digest, like rice cakes; vegetables, fruit or rice. Around six months of age, babies can • fingers of toast, pitta bread eat finger foods – this means or chapatti; food that is big enough to be • cooked pasta twists and The aim is for your baby to get other shapes. used to eating a wide variety of ordinary foods and to your pattern See how your baby responds to of eating – say, three meals a day different flavours and textures with a drink at each meal and two and get them used to chewing or three small, healthy snacks. to help the development of their Giving them a wide variety of speech muscles. At this stage, foods that you and your family how much your baby takes is usually eat will help reduce the less important than getting them risk of them being fussy about used to the idea of eating. what they eat later on.

50 Ready-prepared baby foods to make family meals. Many can produce toxins in a baby’s It can be useful to have a few sauces, soups, breakfast cereals intestines, leading to a very jars, tins or packets of baby food and ready-prepared meals are serious illness (infant botulism), in the cupboard, but don’t use high in salt and sugars. Try to so it’s best not to give your them all of the time. If you buy look out for healthier versions. child honey until they are one baby foods: year old. Honey is a sugar, so Foods to avoid avoiding it will help prevent • check the ‘use by’ date; Salt. Babies should not eat tooth decay as well. • check that the seals on much salt as their kidneys 2 Choking cans and jars have not been cannot cope with it. This means Babies can choke on hard Feeding your baby and young child broken; that you should not add salt to your baby’s food or use stock foods such as raw carrot • carefully read the cubes or gravy, as they are often sticks or large pieces of instructions for preparing high in salt. Remember this apple, small round foods like the food; when you are cooking for the grapes and cherry tomatoes, family if you are planning to give and foods with skin (like • choose ‘sugar-free’ foods, or the same food to your baby, and sausages) or bones (like foods with no added sugars always check food labels. fish). Peel the skin off fruit or sweeteners. and vegetables and remove Sugar. Your baby doesn’t need all bones. You could also Note that although the labels on sugar and by avoiding sugary cut food into small pieces some baby foods say ‘suitable snacks and drinks you will help and lightly cook vegetables from four months’, health to prevent tooth decay. Use like carrots before feeding experts agree that around six mashed banana, breastmilk or them to your baby. It’s also months is the best age to start formula milk to sweeten food if important not to leave your introducing solid foods. necessary. child alone when they are eating. Babies should not eat Remember to check the label Honey. Very occasionally when lying back or when on of any food product you use honey contains bacteria that the move.

51 Nuts. Whole nuts, including into peanut butter. See pages peanuts, should not be given to 35 and 67 for information about children under five years in case peanut allergies. they choke. As long as there is no history of food or other Low-fat foods. Fat is an allergies in your family, you can important source of calories and give your baby peanuts, as long some vitamins for babies and as they are crushed or ground young children.

Getting into good habits Your baby’s diet should Feeding your baby a balanced include foods from each of diet will give them the best the following food groups: chance of growing up into a • dairy and alternatives; healthy child and adult. It’s much easier to establish good eating • potatoes, bread, habits from the start, as it can rice, pasta and other be hard to change things once starchy carbohydrates; your baby is older. • fruit and vegetables; Sources of vitamin C Up to 12 months, babies • beans, pulses, fish, eggs, • Oranges and orange juice are usually willing to try new meat and other proteins; foods, so this is a good time • Kiwi fruit, blackcurrants, to introduce a wide variety of • oils and spreads. mangoes, nectarines and foods with different flavours strawberries and textures. Wherever possible, Red meat (beef, lamb and pork) offer them the same food as you is an excellent source of iron. • Peppers, cabbage, tomatoes are giving the rest of the family. (For further information, see and broccoli page 58.) The easiest way to do this is Sources of vitamin D by giving them a small portion Sources of vitamin A of whatever you are eating. It’s • Safe exposure to summer cheaper, you will know what has • Oily fish sunshine gone into it (especially important • Eggs • Margarines if, for example, your family only eats halal meat) and it will help • Dairy products • Fortified breakfast cereals your baby get used to eating like the rest of the family. • Margarines • Oily fish like salmon, sardines, herring, mackerel • Carrots and dark green and fresh tuna Preparing larger quantities than vegetables (such as spinach, you need and freezing small cabbage and broccoli) portions for later can also save Find out more about vitamin drops time and effort. or supplements on page 55.

52 It’s better for babies and young children under two to have full-fat milk, yogurt and cheese rather than low-fat kinds of milk, yogurt, fromage frais, cheese or spreads.

Shark, marlin and swordfish. These contain large amounts of mercury. You should also limit 2 the amount of tuna your child eats (see page 58). be given to babies under six • Scrambled egg with toast, Feeding your baby and young child months. chapatti or pitta bread. Raw shellfish. Raw shellfish • Cottage cheese dip with can increase the risk of food For more information on food pitta bread and cucumber poisoning so it’s best not to give allergies (including peanut and carrot sticks. this to babies. allergies), see page 67. • Small pieces of soft ripe Food allergies Some meal ideas to try peeled pear or peach. Breakfast Babies are more likely to • Stewed fruit and custard. develop allergies where there • Porridge or unsweetened is a history of atopy (eczema, • Plain fromage frais with cereal mixed with whole cows’ asthma, hayfever or food stewed apple. milk or your baby’s usual milk allergies) in the family. If this with mashed ripe pear. Dinner applies to you, it is strongly recommended that you • Wholewheat biscuit cereal • Cooked sweet potato with breastfeed exclusively for the with milk and stewed fruit. mashed chickpeas and first six months. If you are not cauliflower. breastfeeding, ask your midwife, • Mashed banana and toast • Shepherd’s pie with green health visitor or GP for advice fingers. vegetables. about what kind of formula to • Boiled egg and toast fingers give your baby. Soya-based with slices of ripe peach. • Rice and mashed peas with infant formulas should only be courgette sticks. used on the advice of a GP • Stewed apple, yogurt and • Mashed cooked lentils with or health visitor/family nurse. unsweetened breakfast cereal. Follow-on formula should not rice. Lunch • Minced chicken and vegetable casserole with • Cauliflower cheese with mashed potato. cooked pasta pieces. • Mashed canned salmon with • Mashed pasta with broccoli couscous and peas. and cheese. • Fish poached in milk with • Baked beans (reduced salt potato, broccoli and carrot. and sugar) with toast.

53 Nine months and over From about nine months onwards, you can offer your baby:

• three to four servings of starchy food, such as potato, bread, pasta, cereals and rice, each day;

• three to four servings of fruit and vegetables each Choosing a beaker or cup You can continue to breastfeed day (the vitamin C in fruit It’s important to choose the right or you can give your baby and vegetables will help kind of beaker or cup. A free- between 500 and 600ml (about your baby absorb iron, so flow lidded beaker is better than a pint) of infant formula a day it’s good to include them at a bottle or beaker with a teat. until they are at least a year mealtimes); and Drinks flow very slowly through old. Breastfeeding will continue a teat, which means that children • two servings of beans, pulses to benefit you and your baby spend a lot of time with the (such as peas or lentils), fish, for as long as you choose to teat in their mouth. This can eggs or meat each day. carry on. To help prevent tooth delay speech development and decay, it’s best to avoid sugary damage teeth (especially if they If you have decided not to give or sweetened drinks especially are drinking a sweetened drink). your baby meat or fish, they between meals. As soon as your child is ready, will need two servings a day of encourage them to move on Beakers and cups protein-rich foods, like pulses from a lidded beaker to drinking (dhal, split peas or hummus), It’s a good idea to introduce a from an open cup. Valved non- tofu, textured vegetable protein cup rather than a bottle from spill cups are not recommended (TVP) or eggs. about six months onwards. By as they encourage longer the time your baby is one they drinking times. By now, your baby can fit in should have stopped using with the family by eating three bottles with teats, otherwise mashed or chopped meals a day they may find it hard to break as well as milk. Your baby may the habit of comfort sucking on also like healthy snacks such as a bottle. Using an open cup or a fruit or toast in between meals. lidded free-flow cup (ie non-spill ones) without a valve will also If your baby is on the move, they help your baby learn to sip rather may want more food. Babies have than suck, which is better for small tummies and they need their teeth. Comfort sucking on energy and vitamins for growth, sweetened drinks is the major so make sure you give them full- cause of painful tooth decay in fat dairy products such as yogurt, young children. So if you use a fromage frais and cheese. Cutting bottle or trainer cup, it’s best not back on fat is sensible for adults, to put anything in it other than but not for babies. water, breastmilk or formula.

54 Healthy Start vouchers breastfeeding women and growing children. Your If you have children under four or are pregnant midwife or health visitor will be able to tell you and on certain benefits you may qualify for why vitamins are important. Healthy Start. To claim Healthy Start vitamins, you should post Healthy Start vouchers can be spent on plain the Healthy Start letter you receive with the (with no added ingredients) cow’s milk – whole, vitamin coupon still attached to: semi-skimmed or skimmed; plain fresh or frozen fruit and vegetables (whole or chopped, Business Services Organisation 2 packaged or loose); and infant formula milk that Healthy Start Vitamin Scheme Feeding your baby and young child says it can be used from birth and is based on Pinewood Villa cow’s milk. 73 Loughgall Road Armagh Healthy Start vitamins BT61 7PR

Women and children getting Healthy Start food The Healthy Start vitamins will be posted directly vouchers also get coupons to use to claim free to your home. This postal arrangement applies to Healthy Start vitamins. If you are entitled to only those living in Northern Ireland. Healthy Start the vitamin coupons will be sent to you automatically. Healthy Start vitamins To find out more visit www.healthystart.nhs.uk are specifically designed for pregnant and

Vitamins you where to get them. You will vegetarian or vegan diet is From one to five years all be able to get vitamin drops exactly the same as for babies children should be given vitamin free if you qualify for Healthy on any other diet. See page A, C and D supplements. Some Start (see above). 60 for advice on ensuring your babies may need to be given vegetarian or vegan toddler or vitamin D supplements from Vegetarian and vegan diets child is getting the nutrients birth, see page 56 for more The advice on introducing solid they need for healthy growth information. It's especially food to babies who are on a and development. important to give vitamin drops to children who are fussy about what they eat, children living in northern areas of the UK and those of Asian, African and Middle Eastern origin.

Too much of some vitamins is as harmful as not enough. So always talk to your health visitor, pharmacist or GP before starting any supplements. Your health visitor can give you advice on vitamin drops and tell

55 Feeding your young child Vitamin D By the time your child is starting Vitamin D only occurs naturally in a few foods such as oily fish. It to stand up and take their first is mainly made by the skin when it is exposed to gentle sunlight steps, they should already be between April and September. Encourage your children to play involved in the family meal. As outside, but remember that children burn easily, especially those they get more active and use with fair skin. Children should not be out for too long in the sun more energy, they will need a in hot weather and never let their skin turn red or burn (see page varied, energy-rich diet for good 158 for advice about safety in the sun). health and growth. Babies and children under two have small Everyone aged five years and over, including pregnant and tummies and cannot eat large breastfeeding women, should consider taking a 10 microgram amounts of food all in one go, vitamin D supplement daily. During summer months, most people so they need small meals with will usually get enough vitamin D from sunlight so you may healthy snacks in between. choose not to take a supplement over the summer months (late March/April to the end of September). Like the rest of the family, your toddler needs to eat a variety of products are a good source of page 54 for more information foods from the five groups: vitamin A, which helps the body about choosing the right cup or • dairy and alternatives; to resist infections and is needed beaker). for healthy skin and eyes. • potatoes, bread, rice, At this age, you can replace pasta and other starchy After the age of one, children formula or follow-on with carbohydrates; need less milk than they do as whole cows’ milk or if you are babies. If you are breastfeeding breastfeeding you can just carry • fruit and vegetables; you can just carry on and your on. About three servings per day • beans, pulses, fish, eggs, baby will naturally reduce the of milk, either as a drink or in meat and other proteins; amount they take as they the form of milk-based dishes, increase the amount of food cheese, yogurt or fromage frais, • oils and spreads. they eat. Give smaller drinks will provide the calcium your of whole cow’s milk in cups child needs to develop strong Babies and children (and adults) or beakers, not bottles (see bones and teeth. do not need foods high in fat and sugar such as cakes, biscuits, chocolate and sweets in their diet. If included, they should be offered infrequently, in small amounts and ideally at the end of a meal, which helps reduce the risk of tooth decay.

Dairy and alternatives Young children still need milk. Whole milk and full-fat dairy

56 You should use whole milk and full-fat dairy products until your child is two. Children under two need the extra fat and vitamins in full-fat dairy products. Semi- skimmed milk can be introduced from two years of age, provided your child is a good eater and growing well. Skimmed milk 2 doesn’t contain enough fat so is not recommended for children Potatoes, bread, rice, fibre and they liven up meals Feeding your baby and young child under five. pasta and other starchy with a variety of colours, carbohydrates textures and flavours. Some ideas to try Starchy foods provide energy, It’s good to try to introduce Milk nutrients and some fibre. Whether it’s bread or breakfast lots of different types from an • Porridge, hot oat cereal or cereals, potatoes or yams, rice early age, whether fresh, frozen, cornmeal made with whole or couscous, pasta or chapattis, canned or dried. milk. most children don’t need much encouragement to eat Try to make sure fruit and • Breakfast cereals with milk. foods from this group. Serve vegetables are included in every meal. If possible, give a • Rice pudding, custard or them at all meals and as some mix of green vegetables (like bread-and-butter pudding. snacks. Let your child try lots of different varieties of starchy broccoli and cabbage) and Cheese foods. For more information on yellow or orange vegetables fibre, see ‘Eating as a family’ on (like swede, carrots and squash) • Macaroni cheese, cheese on page 63. and fruit (like apricots, mangoes toast, cheese on vegetables and peaches). Orange fruit and bakes. and vegetables contain beta- carotene, the plant form of • Vegetable soup with grated vitamin A. Also try to include cheese. some citrus fruits (like satsumas • Chunks of cheese and or oranges) and some salad pieces of fruit. (such as peppers and tomatoes) for vitamin C, which may help • Cottage cheese dips. the absorption of iron from other foods. Yogurt and fromage frais Fruit and vegetables contain • Add raw or cooked fruit lots of different vitamins and (fresh, frozen or canned) to minerals, the greater the variety full-fat yogurt or fromage your toddler eats the better, but frais. Fruit and vegetables don’t worry if they will only eat Fruit and vegetables contain • Add yogurt to curry. one or two. lots of vitamins, minerals and

57 • Couscous mixed with peas and flaked fish or cooked minced meat.

• Noodles or rice mixed with shredded omelette and vegetables.

• Chapattis with dhal.

You can try giving your child Some ideas to try plenty of fruit too and try not to wholegrain foods, like wholemeal make a big fuss if they refuse. It Snacks bread, pasta and brown rice as can help if you show them that well. It’s best to introduce these • Fruit and vegetable sticks or you like eating vegetables. Give gradually, so that by the time pieces. vitamin drops as a safeguard (see children are five they are used to page 55 for more about vitamins). • Breakfast cereals (not a healthy adult diet. sugar-coated). Beans, pulses, fish, eggs, It’s not a good idea to give meat and other proteins • Plain popcorn (not wholegrain foods only, because sweetened or salted) or they can fill your child up before Young children need protein and breadsticks. they have taken in the calories iron to grow and develop. Beans, they need. Don’t add bran to pulses, fish, eggs, meat and other • Toast, bagels, bread rolls or cereals or use bran-enriched proteins and foods made from potato bread. cereals as they can interfere with pulses (like tofu, hummus and • Fingers of toasted white your child’s ability to absorb iron. soya mince) are excellent sources bread covered with cheese of protein and iron. Try to give spread. Lots of children don’t like your toddler one or two portions cooked vegetables but will from this group each day. More substantial meals nibble on raw vegetables – like sticks of carrot or peppers – You can give boys up to four • Baked potatoes with baked while you are preparing a meal. portions of oily fish (such as beans and cheese. Your child might be more likely mackerel, salmon and sardines) to eat vegetables if they are a week, but it’s best to give girls • Pasta with vegetable, meat, given in different ways – for no more than two portions a fish or cheese sauces. example on the top of a pizza or week. This is because the low • Pitta bread filled with cream puréed in a sauce. If your child levels of pollutants that oily fish cheese, ham or fish. flatly refuses to eat vegetables, contain can build up in the body keep trying but offer them and may harm an unborn baby during a future pregnancy.

58 is essential for growth and development. Young children in particular need enough of them in their diet to help the brain and nervous system develop normally. The best ones to use are unsaturated oils and spreads such as rapeseed, olive or sunflower oil. 2 Feeding your baby and young child Getting a good start healthy eating from one to five

Meat and fish also contain zinc, • Chickpea curry with which is important for healing vegetables and chapattis. wounds and making many of the body’s processes function • Grilled fish fingers with properly. Zinc can be in short potatoes and peas. supply in toddlers’ diets. • Stir-fried chicken and vegetables with rice. Some ideas to try Tasty snacks • Ham with baked potato and broccoli. You can find out more from • Mashed banana on fingers the Public Health Agency of toast. • Fish curry with vegetables and rice. booklet Getting a good start • Pitta pockets filled with visit pha.site/getting-good- canned salmon and salad. Oils and spreads start-one-to-five

• Scrambled egg on toast with Getting enough healthy fats tomato slices.

More substantial meals

• Beans, lentils and peas made into delicious soups or stews.

• Grilled sausages with baked beans (reduced salt and sugar) and mashed potato.

• Spaghetti bolognese made with lean mince and served with vegetables.

59 Vegetarian and vegan diets If you are bringing up your child on a diet without meat (vegetarian) or without any food from an animal (vegan), they will need two or three portions of vegetable protein or nuts every day to ensure they are getting enough protein and iron. Don’t give whole nuts to children under five, as they could choke. Grind nuts finely or use a smooth nut butter. See pages 35 and 67 for important information about peanut allergy.

especially important up to five have taken in enough calories. The advice on introducing your years of age. Because of this, children being child to solids (see page 46) weaned onto a vegan diet will is the same for vegetarian If you are breastfeeding and you require supplements of vitamin babies as for non-vegetarians. are on a vegan diet, it’s especially B12 and riboflavin. It’s a good However, as your child gets important that you take a vitamin idea to ask a dietitian or doctor older, there is a risk that their D supplement. You may also for advice before starting your diet may be low in iron and need extra vitamin B12. child on solids. energy and too high in fibre. You can help to make sure that all Take care when feeding children For more information on your child’s nutritional needs are on a vegan diet. Young children vegetarian diets, contact The met by giving them smaller and need a good variety of foods to Vegetarian Society more frequent main meals, with provide the energy and vitamins (www.vegsoc.org). one or two snacks in between. they require for growth. For more information on vegan You will also need to make A vegan diet can be bulky and diets, contact The Vegan Society, sure they are getting enough high in fibre and this can mean at www.vegansociety.com calcium, vitamin B12 and that children get full before they vitamin D. Vitamin drops are A healthy vegan diet Energy. Young vegan children need high-calorie foods such as tofu, bananas and smooth nut and seed butters (such as tahini and cashew or peanut butter). See pages 35 and 67 + for information about peanut allergy.

60 They still need starchy foods B12. Your child may also need a but it’s best if these are eaten supplement. in moderation. For extra energy, you could add vegetable oils or Vitamin D. See page 56. vegan fat spreads to foods. Omega 3 fatty acids. Some Protein. Pulses and food made omega 3 fatty acids are found from pulses are a good source in certain vegetable oils, such of protein. Breastfeeding until as linseed, flaxseed, walnut and 2 your child is two or more, or rapeseed. Evidence suggests giving them soya-based formula that these fatty acids may There are some foods that will Feeding your baby and young child milk, will also help to ensure not offer the same protection increase the levels of saturated they are getting enough protein. against coronary heart disease fat in your child’s diet. This is as those found in fish. ‘bad’ fat and there can be a lot Always ask your GP for advice of it in high-fat fast foods, such before using soya-based Fat, sugar and salt as cheap burgers. Crisps, chips, biscuits, cakes and fried foods formula. Nut and seed butters Fat are also high in fat. Although also contain protein (but always Young children, especially under- they tend to be popular with use smooth versions for babies twos, need the concentrated both children and adults, it’s and children up to five). energy provided by fat. There best to limit them at all ages to are also some vitamins that keep your family healthy. It can Iron. See page 58. are only found in fats. That is help to think of these sorts of why foods such as whole milk, foods as ‘extras’ once your child Calcium. Fortified unsweetened yogurt, cheese and oily fish are has eaten well from the four soya drinks are rich in calcium, so important. From the age of other main groups. low in saturated fat and two, you can gradually introduce cholesterol-free. Some foods lower-fat dairy products and cut Because fat is such a are also fortified with calcium, so down on fat in other foods so concentrated source of energy, always check the label. that by the time your child is five it’s easy to eat too much of it they are eating a healthy low-fat and become overweight. Keep Vitamin B12. Fortified diet like the one recommended an eye on the amount of fat in breakfast cereals and some for adults. yeast extracts contain vitamin the food your family eats, and try to keep it to a minimum.

The following tips will help you reduce the amount of fat in your family meals:

• grill or bake foods instead of frying;

• skim the fat off meat dishes like mince or curry during cooking;

61 Your whole family will benefit if you gradually reduce the amount of salt in your cooking. As well as keeping salt off the table, you can also limit the amount of salty foods (such as crisps and savoury snacks) that your child has.

Salt: know your limits • buy leaner cuts of meat and This is the sugar found in fizzy Babies up to one year should lower-fat meat products, drinks, juice drinks, sweets, have no more than 1g of salt a such as sausages and chocolate, cakes and jam. It’s day. For children aged one to burgers with low-fat labels; best to stick to giving these three, the maximum amount is kinds of foods and drinks to 2g of salt a day, and for children • take the skin off poultry your child only at mealtimes and aged four to six, the maximum before cooking – it’s the give them only occasionally. is 3g of salt a day. Find out fattiest part; more about salt, its effects on • reduce the amount of It’s also important to discourage health, daily limits and how to meat you put in stews and your child from sipping sugary cut down at pha.site/salt casseroles, and make up the drinks or sucking sweets too difference with lentils, split often. This is because the more Helpful tips often your child’s teeth are peas or beans; • Try not to give too many exposed to sugar, the more sweet-tasting foods and • for children over two, use damage it can do. drinks, even if they contain lower-fat dairy products like artificial sweeteners rather semi-skimmed milk, low-fat Salt than sugar. These can still spreads and reduced-fat There is no need to add salt encourage a sweet tooth. cheeses; to your child’s food. Most foods already contain enough. • Try not to give your child • use as little cooking oil as Too much salt can give your sweet foods and drinks possible and choose one child a taste for salty foods every day. You will help to that is high in omega 3 and contribute to high blood prevent tooth decay if you polyunsaturates such as pressure in later life. only give them at mealtimes. rapeseed or olive oil. In the UK, pure vegetable oil is often rapeseed oil.

Sugar To help keep your child’s teeth healthy, as well as brushing their teeth twice a day and visiting the dentist every six months, you should cut down your child’s added sugar intake.

62 • Try not to use sweets as a reward.

• Fruit and vegetables contain sugar, but in a form that doesn’t damage teeth. However, the sugar in dried fruit and fruit juice can cause decay if eaten too 2 often. You should only give

your child fruit juice and Feeding your baby and young child dried fruit at mealtimes.

• Encourage your children to choose breakfast cereals that are not sugar-coated.

• Always read the labels. The Eatwell Guide pha.site/ foods, especially those with Sucrose, glucose, honey, eatwell-guide shows how much added bran. It stops young dextrose, maltose syrup and of the various different types of children absorbing important concentrated fruit juice are food you need to eat for a well- minerals such as calcium and all forms of sugar. balanced, healthy diet. Children iron. It is better not to give • Don’t add sugar to milk. under the age of five need a young children brown rice, diet that is higher in fat and wholemeal pasta or bran- • If you flavour milk with lower in fibre than this. enriched breakfast cereals until milkshake flavourings, only they are older, although giving offer it at mealtimes. Include fresh, frozen and canned them some brown bread is OK. fruit and vegetables, salads, • Jaggery can cause the same dried fruit and fruit juices. Include milk, yogurt and fromage damage to teeth as sugar. Include them at each meal and frais. Children need about three Limit foods containing this, as snacks. Try to eat at least five servings a day. You can use low- like Indian sweetmeats. servings a day. fat varieties for children over five who are eating and growing Eating as a family Include bread, potatoes, well. Try to eat together and sit at the breakfast cereals, pasta, rice, table. Try to involve your child oats, noodles, maize, millet, Include meat, fish, poultry, eggs, in preparing food and serving it yams, cornmeal and sweet beans, pulses and nuts. Make when it is safe to do so. Allow potatoes. Make these foods sure children have one or two your child to help with laying and the main part of every meal. servings a day. Choose lean clearing the table. Encourage Choose wholegrain varieties meat, take the skin off poultry the child to try all the foods when you can, but young and cook using the minimum of offered. For adults and children children should not eat fat. Try to eat oily fish at least over five, a healthy, balanced wholegrain foods all the time. once a week. diet usually means eating foods You should avoid giving your from the four main food groups. baby high-fibre versions of

63 How much food do toddlers themselves while being fed. • When your child no longer need? Whichever group your child falls needs their high chair, make Children’s appetites vary into, you can encourage them sure they are sitting at the enormously, so common sense to feed themselves either with a right height for the table, is your best guide when it spoon or by giving them finger otherwise they will find it comes to portion size. Be foods (see page 50). difficult to eat. guided by what your child wants • Use cushions, booster seats – don’t force them to eat if they or even sit them on your don’t want to, but don’t refuse own or someone else’s lap, to give them more if they really but always make sure they are hungry. As long as your child are sitting safely. eats a range of foods, and your health visitor is happy with their Drinks progress, try not to worry too much about the amount they Safety Not all drinks are suitable for are eating. • Make sure there are no babies and young children. The sharp knives on the table following list explains what you Cutlery, chopsticks or within your child’s reach. should give to your child, and fingers? when. • Unbreakable plates or bowls Mealtimes can get messy! It will are ideal for small children, Breastmilk is the ideal drink take time for your child to learn who often decide their meal for babies. It should be given how to behave when eating. The is finished when their plate exclusively for the first six best way that they can learn is hits the floor. months and then continue with by copying you and the rest of your family. That is why it’s good to try to eat and enjoy your food together. Remember to turn off the TV, phones, computers and laptops and enjoy each others company. Some families prefer to eat with their fingers, while others use cutlery or chopsticks. Whichever option you go for, be patient.

By about one year of age, babies should be trying to feed themselves. Some are very independent and want no help – so be patient, even if most of the food misses their mouths! Others will accept your help, but will still want to hold a spoon

64 demand breastfeeding as solid Goats’ and sheep’s milk start using them, but you don’t food is introduced. Your child drinks are not suitable as have to change over as there will naturally reduce the amount drinks for babies under one are no proven health benefits. of breastmilk taken as more year old, as they don’t contain food is eaten. the iron and other nutrients babies need. Providing they are Infant formula is the only pasteurised, they can be used alternative to breastmilk in the once your baby is a year old. first 12 months of your baby’s 2 life. It can be used up to the Unsweetened calcium- time when ordinary cows’ milk fortified milk alternatives Feeding your baby and young child can be introduced (at one year such as soya drinks and other old) or beyond. Follow-on milks milk alternatives like almond are available for babies over six and oat drinks can be given months, but there is no need to from the age of one as part of a Water is the best alternative change over to these. See page healthy balanced diet. For more drink to milk, but fully breastfed 41 for more information about information see babies don’t need any water these and other types of formula. pha.site/childrens-drinks until they start eating solid food. For babies under six months Goats’ and sheep’s milk While breastfeeding is old, take water from the mains drinks are not suitable as encouraged into the second year tap in the kitchen and boil it. drinks for babies under one and beyond, for bottlefed babies Remember to allow the water to year old, as they don’t contain it is recommended that after one cool before giving it to your baby. the iron and other nutrients year all drinks should be given For babies over six months, water babies need. Providing they are from a cup and a feeding bottle can be drunk straight from the pasteurised, they can be used should no longer be used. tap without the need to boil it. once your baby is a year old. Rice drinks Bottled water is not a healthier Whole cows’ milk doesn’t Young children (aged one choice than tap water and usually contain enough iron and other to five years) should not be is not sterile. In fact, some natural nutrients to meet babies’ needs given rice drinks, in order mineral waters are not suitable so it should not be given as a to minimise their exposure for babies because of the drink to babies under one year to inorganic arsenic. Don’t amount of minerals they contain. old. But it’s OK to use cows’ milk worry if you have given your If you need to use bottled water, when cooking and preparing food child rice drinks – there is remember that any bottled water for your baby from six months. no immediate risk of harmful that is labelled ‘natural mineral Semi-skimmed milk can be effects. But in order to reduce water’ might contain too much introduced once your child is two, further exposure to inorganic sodium for babies. provided they are a good eater arsenic, you should stop and have a varied diet. Skimmed giving your child rice drinks. Citrus fruit juices, such as milk is not suitable for children orange juice or grapefruit juice, under five. For convenience, ‘Good night’ milk drinks are are a good source of vitamin lower-fat milks can be used in not suitable for babies under six C, but also contain natural cooking from the age of one. months. After this age, you can sugars and acids that can cause

65 absorption when taken with meals and, if sugar is added, may contribute to tooth decay.

See page 54 for information on choosing the right cup or beaker for your baby or toddler.

Food additives Food contains additives for a can encourage children to Non-cows’ milk formula variety of reasons: to prevent develop a sweet tooth. If you food poisoning, to stop it going Only use soya-based infant want to use squashes, flavoured off and to provide colour, flavour formulas on the advice of milk and juice drinks, keep them or texture. Some food additives your GP. Babies who are for mealtimes, make sure they are natural substances, others allergic to cows’ milk may are diluted well and always give are synthetic. Any additives put also be allergic to soya. them in a feeder cup rather than into food must, by law, be shown Goats’ milk, even if it has a bottle. These drinks should on the label. An ‘E’ number been specially formulated for never be given as a bedtime means that the additive has babies, should not be given drink as this can be particularly been tested and passed as safe to babies under one year. bad for tooth decay. You should for use in European Union (EU) also try to keep drinking times countries. Numbers without an tooth decay. Babies under six short. ‘E’ in front are allowed in the months should not drink fruit UK, but not in all EU countries. juices. Vitamin C may help with Fizzy drinks are acidic and iron absorption, so if your baby can damage tooth enamel, so is a vegetarian you may be they should not be given to advised to give them diluted babies and toddlers. fruit juice (one part juice to 10 parts boiled, cooled water) with Diet drinks and ‘no added their meals after six months. To sugar’ drinks, whether prevent tooth decay, give fruit squashes or fizzy drinks, are not juice at mealtimes only. intended for babies, toddlers or young children. This is in line Squashes, flavoured milk with advice from the British and juice drinks contain sugar Dental Association. and can cause tooth decay even when diluted. They are not Baby and herbal drinks suitable for young babies. For contain sugars and are not older babies and toddlers, these recommended. drinks can lead to poor appetite, limited weight gain and, in Tea and coffee are not toddlers, loose stools. Even suitable for babies or young those with artificial sweeteners children. They reduce iron

66 a diagnosed eczema or a diagnosed food allergy, or if there is a history of allergy in your child’s immediate family (if parents, brothers or sisters have an allergy such as asthma, eczema, hayfever, or other types of allergy) then your child has a higher risk of developing peanut 2 allergy (see page 35). In these cases you should talk to your Feeding your baby and young child GP, health visitor or medical allergy specialist before you give Food allergies sometimes trigger development peanuts or peanut-containing of a food allergy. foods to your child for the first Some children experience time. unpleasant reactions after When you give these foods to eating certain foods. Most your baby for the first time, it’s Remember not to give whole children grow out of this, but a good idea to start with one peanuts or nuts to children in a very few cases foods can at a time, so that you can spot under five because of the risk of cause a very severe reaction any allergic reaction. If you think choking. (anaphylaxis) that can be life- your child is having an allergic threatening. reaction, you should seek urgent If you think your child is having medical attention. Common an allergic reaction to a food, symptoms of an allergic reaction you should seek urgent medical include one or more of the attention. Don’t be tempted following: coughing; dry, itchy to experiment by cutting out throat and tongue; itchy skin or a major food such as milk as rash; diarrhoea and/or vomiting; this may mean your child is wheezing and shortness of not getting the nutrients they breath; swelling of the lips and need. Talk to your health visitor throat; runny or blocked nose; or GP, who may refer you to a The foods most likely to cause a sore, red and itchy eyes. registered dietitian. problem for young children are You may have heard that peanuts, nuts, seeds, milk, eggs, For advice on asthma and previous advice was to avoid wheat, fish, shellfish or food allergies, contact Asthma UK’s giving your child peanuts before containing these. helpline on 0800 121 62 44 the age of three years – this or go to www.asthma.org.uk, or advice has now changed, based If you choose to start giving call the Allergy UK helpline on on the latest research, and you your baby solid foods before 01322 619898. Lines are open only need to avoid giving peanuts six months (after talking to your from Monday to Friday, 9am to before six months of age. health visitor or GP), don’t give 5pm. The Allergy UK website is them any of the foods above If your child already has at www.allergyuk.org until after six months of age. a known allergy, such as This is because these foods can

67 • make reduced-sugar jellies and add canned mandarins or slices of fruit;

• offer one or two ready- diluted fruit juices to drink rather than carbonated drinks;

• fruit scones need very little preparation; Party time! healthy but fun party foods: • decorate small plain biscuits Parties are a great time for • make tiny sandwiches and with cheese spread and children to try different types of cut them into different a small piece of fresh or foods. It’s a special occasion, shapes. Use fillings that cut canned fruit to add colour; so have some treats as well as easily, like wafer-thin ham, some familiar everyday foods. cheddar cheese spreads and • serve ice cream with fresh or Try the following egg mayonnaise; canned fruit; ideas for • offer bowls of plain popcorn, • don’t forget the birthday breadsticks, raw vegetable cake for the end of the meal! sticks and baby tomatoes;

Some common problems with eating It’s perfectly normal for toddlers to refuse to eat or even taste new foods. Children will usually eat enough to keep themselves going, so try not to worry unless your child is not putting on weight as quickly as they should (see page 107) or is obviously ill.

As long as your child eats some food from each of the four food groups – even if it’s always the same old favourites – you do not need to worry. Gradually introduce other food choices or go back to the foods your child did not like before and try them again.

68 Remember, as long as your child is active and gaining weight, they are getting enough to eat, even if it doesn’t look like it to you.

Never force a child to eat

The best way for your child to learn to eat and enjoy new 2 foods is to copy you, so try to eat with them as often as you • if your child rejects the food, • if your child fills up with juice Feeding your baby and young child can so that you can set a good don’t force-feed them. Just or squash between meals and example. Children are very quick take the food away without refuses milk or snacks, try to pick up on your own feelings comment; try to stay calm gradually reducing the amount about food. Perhaps you are on even if it’s very frustrating. of juice or squash they have, a diet, or have a weight problem, diluting it well with water, and • don’t leave meals until your or are just very keen to eat give them a small amount of child is too hungry or tired to healthily. Your child may well be food - children sometimes get eat; picking up on your anxiety and/ thirst and hunger mixed up and say they are thirsty when or using mealtimes as a way to • your child may be a slow eater they are actually hungry; get attention. so you may have to be patient; • try to make mealtimes These tips can help: • don’t give too many enjoyable and not just about between-meal snacks; eating - sit down and have a • give your child the same you could limit them to, chat about other things; food as the rest of the family, for example, a milk drink and eat your meals together and some fruit slices or a • if you know of any other if possible; small cracker with a slice of children of the same age cheese; • give small portions and praise who are good eaters, ask them to tea; a good example your child for eating, even if • you may find it useful to can work wonders, as long they only manage a little; take the attitude that a food as you don’t talk too much refusal is ‘not liked today’; • it can take up to 10-15 tries about how good the other just offer the food again in a before your child will accept children are; different way, as this may be a new food; more acceptable; • ask an adult who your child likes to eat with you; • it’s best not to use food as sometimes a child will eat a reward, otherwise your for someone else, like a child will start to think of, grandparent, without any fuss; say, sweets as nice and vegetables as nasty; instead, • children’s tastes change reward them with a trip to - one day they will hate the park or promise to play a something, a month later game with them; they will love it.

69 Frequently asked • some crackers, breadsticks questions or rice cakes with cheese; How do I get a relative to • a bowl of cereal with milk; stop giving sweets to my child? • a piece of fruit.

Suggest they give a small book, I have heard that high-fibre pencil or other non-edible foods are not suitable for gift instead. If your child does young children. Why? have sweets, try keeping them to a special ‘treat’ day, once Foods that contain a lot of fibre a week. Remember that the (like wholemeal bread and number of times that teeth pasta, brown rice and bran- come into contact with sugar is based breakfast cereals) can as important as the amount of fill up small tummies, leaving sugar. So sweets are best eaten little room for other foods. This example a peeled satsuma or in one go rather than over the means that your child gets full washed, chopped up seedless course of an hour or two. They before they have taken in the grapes. A box of raisins is will do least damage to teeth if calories they need. Bran also fine if eaten at lunchtime. If you keep them for mealtimes. prevents important minerals you include a fromage frais or For more information about from being absorbed. It’s good yogurt, don’t forget a spoon. caring for your child’s teeth ask for your child to try different And a piece of kitchen towel is your health visitor or dentist. varieties of starchy foods, but always useful. If the lunchboxes don’t use only wholegrain foods are not refrigerated at nursery, What snacks can I give before your child is five years use an insulated box with an instead of biscuits or old. ice pack to keep food safe and crisps? cool. If you have a leak-proof What can I pack in a beaker, you can give milk, water You could try: lunchbox for my three- or well-diluted fruit juice. • raw vegetable sticks such as year-old when they go to cucumber and carrots; nursery? My child will only drink Try to choose two savoury sugary drinks. What can I • a plain yogurt with a banana options, some fruit, a sweet do? sliced into it; option (yogurt, fromage frais, Frequent sugary drinks increase • a slice of toast with yeast scone or currant bun) and a the chance of tooth decay. See extract, hummus or a slice of drink. Good sandwich fillings page 64 for a list of suitable ham; are canned tuna or salmon, drinks. If your child will only hummus, hard or cream cheese, drink sugary drinks, it can take ham or peanut butter (see page some time to break the habit. 35 for advice on peanut allergy). Start by diluting them really well You could add a few vegetable with water and offering them in sticks (carrots, peppers or smaller quantities, in a beaker at cucumber) to munch on and a mealtimes. container of bite-sized fruit – for

70 Keeping active Children love using their bodies to crawl, walk, run, jump and climb. The more opportunities you give them to burn off some energy, the happier they will be. You will probably find they sleep better and are more easy going, 2 too. By giving them the chance to exercise, you will be helping • children of pre-school • toys that your child can pick Feeding your baby and young child their muscle development and age who are capable of up and move around will help general fitness, and laying down walking unaided should be improve their coordination habits that will help them grow physically active for at least and develop the muscles in into fit, healthy adults. Visit pha. 180 minutes (three hours) their arms and hands; site/kids-physical-activity for spread throughout the day; practical ideas for physically • there may be activities for active play. parents and children at your local leisure centre; Here are some ways to keep your child active:

• let your baby lie down and kick their legs; • let your toddler walk with you, rather than always using the buggy; • you can take your baby • toddlers and young children swimming from a very young love going to the park where age - there is no need to they can climb and swing, or wait until they have been just run around; immunised.

• babies should be encouraged to be physically active through floor play and water play in a safe environment;

• once your baby has started crawling, let them crawl around the floor - you will need to make sure it’s safe first;

71 start brushing their teeth. Buy a baby toothbrush and use it with a tiny smear of fluoride toothpaste. Check with your dentist whether the brand you are using has enough fluoride for your baby’s needs. Don’t worry if you don’t manage to brush much at first. The important thing is to get your Teeth There are 20 primary teeth in baby used to teethbrushing as all, 10 at the top and 10 at the part of their everyday routine. Most babies get their first milk bottom. You can help by setting a good tooth at around six months, example and letting them see usually in front and at the The first permanent ‘second’ you brushing your own teeth. bottom. But all babies are teeth come through at the back different. Some are born with at around the age of six. Gradually start brushing your a tooth already through, while child’s teeth more thoroughly, others still have no teeth by the Brushing your child’s teeth covering all the surfaces of the time they are a year old. Most teeth. You should do it twice a day will have all their milk or primary As soon as your baby’s teeth – just before bed, and at another teeth by about two-and-a-half. start to come through, you can

Teething your pharmacist, GP or health visitor. Do not use Some teeth come through with no pain or trouble teething jewellery like necklaces, bracelets and at all. At other times you may notice that the gum anklets. These products are unsafe. is sore and red where the tooth is coming, or that one cheek is flushed. Your baby may dribble, gnaw It can be tempting to put all sorts of things – and chew a lot, or just be fretful. rashes, crying, bad temper, runny noses, extra-dirty nappies – down to teething. If you are unsure It can help to give your baby something hard to about your child’s health, seek advice. chew on, such as a teething ring, a crust of bread or breadstick, or a peeled carrot (stay nearby in case of choking). It’s best to avoid rusks because almost all brands contain some sugar. Constant chewing and sucking on sugary things can cause tooth decay even if your baby has only one or two teeth. For babies over four months old, you can try rubbing sugar-free teething gel on their gums. You can get this from the pharmacist.

For younger babies, talk to your GP or health visitor. You may also want to give sugar-free baby paracetamol or ibuprofen. Follow the instructions on the bottle for your child’s age, or check with

72 Fluoride Fluoride is a natural element that can help prevent tooth decay. It occurs naturally in foods, and is also in some water supplies, although the levels are usually too low to be of much benefit.

You can give extra fluoride in the form of drops (for babies) or tablets (for children), but you should not do this 2 if you live in an area where fluoride is naturally present or Feeding your baby and young child has already been added to the water. Ask your dentist for advice. Fluoride in toothpaste is very effective. Use a tiny smear for babies and a pea-sized amount for toddlers and children. time that fits in with your routine. You will need to carry on helping teeth. HSC dental treatment Not all children like having their your child brush their teeth for children is free. Take your teeth brushed, so you may have until you are sure they can child with you when you go to to work at it a bit. But try not to let do it well enough themselves. the dentist, so they get used to it turn into a battle. Instead, make You should brush or supervise the idea. If you need to find a it into a game, or brush your own toothbrushing until they are at dentist, you can ask at your local teeth at the same time and then least seven. health centre or contact your help your child ‘finish off’. local health trust. Taking your child to the The easiest way to brush a dentist Cutting down on sugar baby’s teeth is to sit them You can take your child to a Sugar causes tooth decay. on your knee with their head dentist as soon as they are Children who eat sweets every resting against your chest. born, even before they have any day have nearly twice as much With an older child, stand behind them and tilt their head upwards. Three to six year olds should use a pea-sized amount of toothpaste. Brush the teeth in small circles covering all the surfaces and let your child spit the toothpaste out afterwards. Rinsing with water has been found to reduce the benefit of fluoride. You can also clean your baby’s teeth by wrapping a piece of damp gauze with a tiny amount of fluoride toothpaste on it over your finger and rubbing this over their teeth.

73 sugar in preprepared baby foods (even the savoury ones), rusks and baby drinks, especially fizzy drinks, squash and syrups.

• You should only give sweet foods and fruit juice at mealtimes. Well diluted fruit juice containing vitamin C bad because they ‘bathe’ the and given in a cup with a Happy Smiles teeth in sugar for long periods meal may also help iron Happy Smiles is a local of time. Acidic drinks such as to be absorbed. Between programme to promote good fruit juice and squash can harm meals, stick to milk or water. dental health in children teeth too. This is why it’s better and young people. More to give them at mealtimes, not in information is available at between. pha.site/happy-smiles The following tips will help you decay as children who eat reduce the amount of sugar in your child’s diet and avoid tooth sweets less often. It’s not just • Try not to give biscuits or decay: the amount of sugar in sweet sweets as treats – and food and drinks that matters, • From the time your baby ask relatives and friends it’s how often the teeth are in is introduced to solid food, to do the same. Use things contact with the sugar. Sweet try to encourage them to like stickers, badges, hair drinks in a bottle or feeder cup eat savoury food. Watch for slides, crayons, small books, and lollipops are particularly notebooks and colouring books, soap and bubble baths. They may be more expensive than sweets, but they last longer too.

• If children are having sweets or chocolate, it’s less harmful for their teeth to eat them all at once and at the end of a meal than to eat them little by little and/or between meals.

• At bedtime or during the night, give your baby milk or water rather than baby juices or sugar-sweetened drinks.

74 • If your child needs medicine, ask your pharmacist or GP if there is a sugar-free option.

• Try to avoid giving drinks containing artificial sweeteners, such as saccharin or aspartame. 2 If you do, dilute them with

water (read the labels Feeding your baby and young child carefully).

• It’s OK to use bottles for expressed breastmilk, infant formula or cooled boiled water but using them for juices or sugary drinks can increase tooth decay. It’s best to put these drinks in a cup and keep drinking times short.

• Between six months and Monitoring sugar content one year, you can offer drinks in a lidded non-valved Sucrose, glucose, dextrose, maltose, fructose and free-flowing cup (see page hydrolysed starch are all sugars. Invert sugar or syrup, 54 for more on choosing honey, raw sugar, brown sugar, cane sugar, muscovado and the right cup or beaker). concentrated fruit juices are all sugars. Maltodextrin is not a sugar, but can still cause tooth decay. • It might help to check your whole family’s sugar intake and look for ways of cutting down.

75