Feeding Your Child PDF Version 226 Pages • 3.61 Mo

Caroline Cloutier ..... �� . . Breastfeeding your baby Breastfeeding Food-related problems Feeding your baby Feeding ..... �� ...... �� ...... �� ...... 496 518 570 382 414 510 366

F eEDIng your child 366 Feeding your child Feeding your baby Vitamin D: Not yourordinary vitamin! Not D: Vitamin baby premature a Feeding Baby’s needs changing pressure Social intolerances and Allergies (colic)Excessive crying Regurgitation Gas Burping Hiccups spurts Growth Is your baby drinking enough milk? Feeding schedule Hunger signs of love An act ��

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Jean-Claude Mercier necessarily needing to drink much milk. much to drink needing necessarily Your to suck. and try baby might want to suck without will their hands put to their their stick tongue out mouth, babies most birth, child. after In the hour their newborn intimateThese give achance parents moments to observe new family. the whole for and moving moment baby. to toher get know is This an intense opportunity adapt It to also world. gives life in an the outside mom andreassuranceof comfort that your helps newborn is asource contact “skin-to-skin” This birth. right after well, the goes baby mom’s is on put delivery If tummy of love act An of warmth andsecurity.feeling and child that of intimacy amoment provides baby with a of ensuringmother matter baby is It offers well nourished. a than more is Breastfeeding requirements. immunity and all It is milk of their the nutritional only that meets needs. adapted to children’sHuman milk is unique andperfectly your baby close to you. hungry. You will easily recognize more them you if keep are all signs These motions. sucking that your baby is stretch, his bring hands to his face or andmake mouth hisbeneath eyelids, will he move his arms andlegs, of ways. His breathing will change, his eyes will move Your in baby any will show you is number he hungry signs Hunger your baby. to Make with done. of such interact the most moments than more to asimplebe so much task that be needs can one your Feeding little the warmth of your body! She lovesher stomach. of your the sound voice and in yourSnuggled your arms, the milk baby feels filling in the livesrole of you andyour baby. andwill playFrequent an important is important contact yourFeeding baby is andsharing. atime of intimacy 367 Feeding your child Feeding your baby There’s no point waiting for your baby to cry or get angry As the weeks and months pass, feeding frequency before starting to feed him. Changing a diaper to wake and duration, like sleeping patterns, may vary from one a sleeping baby is sometimes a good idea, but is best time or one day to the next. No two babies are the same. avoided if your little one is very hungry. Do whatever Some babies have a regular schedule, while others works best for you. are more unpredictable. As your baby gets older, feedings tend to become shorter and less frequent.

Feeding schedule Your baby’s schedule depends on a variety of factors: • Age Over the first few days, most babies can’t distinguish Appetite between hunger and their need to suck. They want to • be fed every time they wake up. Some babies, especially • Temperament and mood those with jaundice, may remain drowsy until they regain How effective she is at sucking and the speed at which their birth weight and sometimes may forget to wake •

Feeding your baby the milk flows up to feed. They need to be stimulated, even during the night, to make sure they drink enough. • The time of day

Keep in mind that newborn babies are in a period Breast milk is easy to digest since it is perfectly adapted of intense learning. They must “learn” to feed, which to babies. Breastfed babies usually feed 8 times or more is why they may need to feed longer and more often. per day, especially during the first few months. Feeding child your 368 nurse may tonurse able help. be CLSC your or too muchis drinking midwife too little, or to up? pick her you the impression If get that your baby she’s you andwants because uncomfortable Is she crying your Is hungry? she baby’s needs. Has drunk she enough? youIn the beginning, may haveunderstanding difficulty feeds. that between will she the hope wait longer signs of hunger, don’t she’s force but when her in full shows she drink her when Let full. or your baby is hungry Instead, you will have to to learn recognize signs that each feeding. she will need per day; andit’s as just hard tohow much know milk It’s hard to tell how many times your baby will feed times a day. on commercialfed infantmore 6or formula tend to feed stomach has to work harder. why is This probably babies the baby’s to because take digest longer They milk. commercialMost infant cow’s formulas are from made important to adapt to your baby’simportant appetite. Étienne St-Michel Whether you breastfeed or bottle-feed, it’s it’s bottle-feed, or you breastfeed Whether 369 Feeding your child Feeding your baby Is your baby drinking After the first week, your baby will urinate at least 6 times in 24 hours if she is drinking enough milk. Each miction enough milk? (urination or pee) generally contains 30 ml to 45 ml of urine. The urine is clear and odourless. Before you go back home, make sure you can tell if your baby is feeding well and getting all the milk he needs. Talk Stools to your midwife or a nurse at the hospital if in doubt. Over the first 2 or 3 days of your baby’s life, stools will When your baby is feeding enough, the appearance and be dark and sticky; this is called meconium. Digesting milk quantity of his stools and urine will change. Here are a few will bring about a change in stool appearance. Gradually, signs to help you determine if your newborn is getting they will become less sticky and a dark green colour. If your enough milk. baby is drinking enough, there will be no meconium at all left in his digestive system after the fifth day. Stools will Urine be yellow or green if he is drinking breast milk, or greenish

Feeding your baby beige if he is being fed commercial infant formulas. Urine is darker and more concentrated over the first 2 or 3 days. Your baby may also have orange stains (urate If your baby is drinking enough, his stools will be liquid crystals) in her diaper: this is normal for the first 2 days. In or very soft. He may have 3 to 10 bowel movements the first week, the number of times your baby pees will per day over the course of the first 4 to 6 weeks. If your increase by one every day: baby doesn’t have at least one bowel movement per day, he might not be drinking enough. After 4 to 6 weeks, Day 1 = 1 time • some babies fed with breast milk will have fewer but very • Day 2 = 2 times substantial bowel movements even if they are drinking enough (e.g., one bowel movement every 3 to 7 days). • Day 3 = 3 times, etc. Feeding child your 370 your infant, read For information more urine, andthe size on stools of nurse, your aCLSC your or doctor. family midwife contact that youIf are worried your baby enough, is not drinking is drinking enough. no point weighing day your he if baby to every see sign that your baby There’s enough. is drinking the age of 3 months. weight Regular gain is agood 0.6 to 1.4he can gain between kg month until per weight,Once your his baby has birth regained (10by around week the second to 14 days). day weight andwill regain hisaround the fourth birth backon again it putting willstart He first few days. weight (5 alittle lose nonetheless to 10%) over the Even if your is newborn drinking enough, he will Weight gain every day way to isevery agood tell enough. is she if drinking The number of times your baby pees and poops andpoops of times number your babyThe pees The newbornThe , page 272, page . • • • • • enough drinking not is baby your that Signs • • • • • enough drinking is baby your that Signs

24 hours between the age of 5 days the age and 4weeks. 24 hours between two days. of it. little babies). for formula-fed day per and6times more or babies for breastfed H H T H H weight. on is putting He in sufficient andpoops quantities. pees He drinking. seems fullHe after (8 day well per times more or and often feeds He wakesHe his up hungry. on own when here are orange stains in his urine after the first the first in stains his arehere orange after urine e is very drowsy and very difficultfeeding. to wake drowsyfor andvery e is very is stools still contain meconium after the fifth day. stillis the fifth contain stools meconium after is is urine dark yellow (like an adult’s) there is or very e has fewer than bowel movements one per 371 Feeding your child Feeding your baby Growth spurts Hiccups

During your baby’s first months, she will experience It’s normal for your baby to get the hiccups, especially rapid growth spurts. Her appetite will suddenly increase after drinking. Hiccups don’t seem to bother babies. and she will want to be fed more often, sometimes every They will stop by themselves after a few minutes. hour. Such growth spurts generally last a few days and may occur at any time during the first few months. Some babies will have more growth spurts than others. Growth Burping spurts occur most frequently around: • 7 to 10 days All babies swallow varying amounts of air as they drink. If your baby is calm during and after feeding, he probably 3 to 6 weeks • doesn’t need to burp. • 3 to 4 months

Feeding your baby But if your baby seems to be in a bad mood or squirms while drinking, the first thing to try to calm him down During growth spurts, your baby will need to drink is to burp him. One or two burps are usually enough, more and very often in order to meet her needs. but more may be required for babies that drink quickly or from a bottle. Feeding child your 372 needs to burp. needs to he’s if don’t. Let him be asleep. wake He’ll uphe if insistDon’t your if baby won’t babies burp: some he’s if to check burps, see he still hungry.After • • Here’s how to your burp baby: How toburpyour baby

shoulder or sit him down on your lap. Gently rub or tap his afew tap minutes. or for rub back Gently your baby inHold an upright against position your a few minutes. few a To your burp baby, his gently tap or for rub back

Geneviève Colpron 373 Feeding your child Feeding your baby Gas Regurgitation

Gas is perfectly normal and isn’t caused by milk! Most babies regurgitate or “spit up,” some more than others. They may regurgitate right after feeding or a little Newborns’ intestines start digesting milk right away after later. Sometimes, you may have the impression your baby the first feedings. This new sensation may make babies has regurgitated almost everything he drank, but even uncomfortable for the first few days. They may squirm though it may seem a lot, most regurgitations only contain or cry and often have lots of gas. They may need to be a small amount of milk. calmed and comforted in their parents’ warm arms. Regurgitation happens because the valve that prevents milk Even as they get older, most infants will continue to have flowing back toward the mouth has not fully developed. a lot of gas. Some babies burp less and expel air this Regurgitation tends to diminish at around 6 months, and way instead. If gas is making your baby uncomfortable, stop completely around one year. Although it is a nuisance try to soothe her in your arms, shifting her position to parents, it is normal for babies. Feeding your baby or moving her legs. Feeding child your 374 • • • • your if baby adoctor to see It is best harmless. is perfectly regurgitation there’s of the time, reason no Most to concerned. be as andgaining your spirits long weight, baby is As in good

Isn’t gaining enough weight enough gaining Isn’t Wets less than his before diapers several vomits timesProjectile aday to in pain be Seems feeding breaks to her. soothe breaks feeding your Burp child take or uncomfortable. bloated and she may of air. swallow lots make can This feel her to cry, chokes andstarts too fast, yourIf baby drinks to diet. is unrelated and normal page 283) time hard along andfor fewmonths, healthy a the first During babyvery may cry (colic) crying Excessive . Most of the time, is. Most excessive completely crying (see Excessive crying (colic)Excessive crying ,

375 Feeding your child Feeding your baby Feeding your baby Feeding child your 376 baby’s needs. aformula adapted to recommend can your A doctor may intolerant be to and require formula. them aspecial with commercial fed In babies rare cares, infant formulas (see to on milk in them her and passed by their mothers situations, proteins they to may certain ingested react allergic to cannot be Babies their mother’s In rare milk. intolerances and Allergies Breastfed babies and allergies babies Breastfed , on page 574) . for your baby andyou. baby. the days As by, go best you willwhat find works andtake how careof your for tono single recipe feed to do way. things acertain that there is remember Just father, or amother As you may pressure up feeling end will tell you to wait. will say you should introduce early; others other very foods Some not. others in favour will be Some of breastfeeding, will give regularly They you tips, information andadvice. have different similarchoices made very or to your own. deal over generations. the two past People around you will the way has agreat are changed fed babies In Québec, S ocial pressure 377 Feeding your child Feeding your baby Baby’s changing needs Feeding a premature baby

The first few weeks are a learning experience for the whole A premature baby may not be able to feed by himself family. Feeding your baby will become an important part for the first few weeks. It all depends on how early he was of your day. And it’s not always easy to know if your baby born and how healthy and heavy he is. is hungry or getting enough milk. At the start, he may need to be fed a special formula Over time, you’ll fall into a routine as your baby learns to intravenously. Then he will be able to be fed milk directly show her needs more clearly. She will become more skilled into his stomach through a tube. After that he will gradually and efficient at sucking. She will spend less time feeding start drinking from his mother’s breast or a bottle. and sometimes drink less frequently. Feeding your baby will be easier. Premature babies’ digestive systems are immature (not yet developed). Premature babies are also more After 3 months, your baby will start interacting a lot susceptible to certain infections. Feeding your baby with others. She will be alert and interested in everything happening around her—even when she’s drinking! Feeding will become a time of sharing between you and your baby. Feeding child your 378 your child, it’s never too late to change your mind. for your baby. you If weren’t planning to breastfeed baby. you are care your expressing helping By milk, of your premature all needs the special milkBreast meets encourage you to team will medical that help The prevent infections. milkBreast is easily andcontains digested express

your milk to give to your baby. antibodies

babies will be used. will be babies milk special premature for yourIf child is not breastfed, to the milkmay atime. added for you express be prematurely, your very If baby is born minerals calories or 379 Feeding your child Feeding your baby Vitamin D: Not your Your healthcare professional will help you determine whether your baby needs a vitamin D supplement. ordinary vitamin! If so, you can find the necessary supplements at your drug store. Vitamin D plays an essential role in calcium absorption and bone health. Your drug insurance plan should cover vitamin D supplements if you have a prescription from your doctor. It’s true that exposure to the sun’s rays provides vitamin D. However, direct sunshine isn’t recommended for babies. Because of this, you have to find another way to fulfill their vitamin D needs. Feeding your baby Feeding child your 380 Dominic Roy 381 Feeding your child Feeding your baby 382 Feeding your child Milk Other types of milk types Other commercial infant formula Handling (commercial formula Commercial infant milk) milk expressed Handling composition of human milkThe milk breast Producing milk Mother’s Which milk is best? ��

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Mahalia Gagnon your or baby. older newborn which milk toabout to know give you need everything months. baby In inthis the first chapter, you’ll find you will give food it’s the your only baby’s In fact, diet. yearIn of the first life, milkplays a crucial in role your their babies commercial infant formula. commercial infant babies their to give anddecide hoped or is not what they’d expected find thatOthers breastfeeding despitethem, the benefits. womenSome find doesn’tthatbreastfeeding work for a few days, afew months, over or ayear. It’s up to you. six months more. or You for to breastfeed decide can and close to 50% continue attheir babies birth, for Today, close to breastfeed 85% mothers of Québec years more. until or of two the age breastfeeding that itis they recommended continuesolid foods, recommendation. Once babies have eating started Dieticians andHealth Canada allthis of Canada, echo six months Canadian of life. Paediatric The Society, milk breast exclusively fed that babies be the first for Health professionals the world over recommend best? is milk Which 383 Feeding your child Milk It is recommended that babies who are not fed breast milk For babies who are not fed breast milk, the Canadian be given cow’s milk that has been processed and adapted Paediatric Society, Dietitians of Canada and Health Canada into commercial infant formula. all recommend using an infant formula enriched with iron up to the age of 9 to 12 months. Cow’s milk is completely The baby formula industry processes cow’s milk to make inappropriate for babies under 9 months. its nutritional content closer to that of mother’s milk. But commercial infant formulas still can’t match mother’s However you feed your baby, your baby needs you, milk. They don’t contain the same proteins, they don’t your attention and your love. You can fulfill his need supply antibodies, and they don’t provide immune for warmth, security and affection by holding him in factors, growth hormones or white blood cells (see The your arms when you feed him and maximizing skin-to-skin composition of human milk, page 387). Babies who aren’t contact, particularly in his first few weeks. You can also fed with breast milk have a higher risk of ear infections, massage him, take a bath with him and use a baby carrier gastroenteritis, bronchiolitis, pneumonia and to help you “stay in touch.” other problems. Milk Feeding child your 384 discomfort if breasts are engorged. reduce helps also quickly. Frequent more stimulation in includingduring at this night, period, milk to come seems baby or changes and will happen even if your you don’t breastfeed youris when milk “comes in.” by It is hormonal caused and takes ablueish yellowish-white on –or colour. This increasesproduction rapidly. milk The becomes clearer milk birth, giving day after andfifth the second Between before birth. It also cleans intestines her of the residues that build up and cells It supplies large of white amounts blood needs. proteins, vitamins what andminerals—just your newborn rich in Colostrum is colostrum. very is called after birth yellowish thick, milkThe thatfew comesdays in the first milk Mother’s antibodies express that protect your baby from infections. infections. from baby your protect that your milk. If breasts are stimulated often are stimulated breasts often If your milk. and according to the time of day. as grows. she Milk also changes over the course of afeeding Your milk changes over time to adapt to your baby’s needs ordinary vitamin! their food from of it until enough babies they are getting breastfed A supplement of Vitamin D is recommended for for Dis recommended ofA supplement Vitamin (see , page 380) Vitamin D: Not your D: Not Vitamin .

385 Feeding your child Milk Producing breast milk The breast produces milk continuously all day long. It accumulates in breasts waiting for your baby to nurse or for the milk to be expressed. The speed at which milk Pregnancy hormones prepare the breasts for breastfeeding. is produced depends on how much milk has accumulated Milk production begins at the end of pregnancy, which in the breast. Breasts have a natural mechanism that adjusts is why some women experience some leaking during this to the baby’s needs and prevents the mother from being time. Whether your baby is born on his due date or earlier, uncomfortable. It works like this: there will be milk for him. • The more the breast is emptied, When milk is removed from the breast, it stimulates the more quickly it will produce milk. the breast to produce more. This stimulation can come The longer the breast is left full, from the sucking action of your nursing baby or from • the more slowly it will produce milk. expressing milk by hand or with a breast pump. Your breasts will produce milk as long as your baby nurses • The more often the breasts are emptied, or the milk is expressed. the more milk they will make. Milk • The less often the breasts are emptied, the less milk they will make. Feeding child your 386 a few weeks. is stimulated, milk will the other breast within making stop Each breast produces milk independently. only If one breast afew days. milk after making stop stop all at once, your breasts will and become engorged your breasts from becoming and engorged sore. you If they will progressively will This prevent producingit. stop you If gradually removing stop milk your from breasts, inself-adjusts afew days. milk production are stimulated the breasts often, more If milk they will produce. will they milk The more often the breasts are emptied, the more the more are emptied, the breasts often more The and taste of breast milk. of breast and taste influence the composition factors Certain human milk. To date, over have in identified 200 components been lifelong protection. that are thought bacteria to provide himin good with andinfections develop his milkBreast has that What’s facilitate more, itcontains digestion. enzymes (see to develop,they need with the exception D of vitamin amount of vitamins andminerals baby with the exact brain and eyesupport development. It provides each acids that 3fatty including omega babyfats your needs, milkBreast is up of proteins, made andall sugars, the and age. to adapt to your period baby’s needs breastfeeding Breast milk composition changes throughout the of human milk composition The Vitamin D: Not your ordinary vitamin! Not D: Vitamin antibodies that help your baby fight fight your baby that help immune system , page 380) . It is also rich . 387 Feeding your child Milk What influences the composition of milk Most breastfeeding mothers can eat whatever they like, including foods deemed risky during The mother’s diet your pregnancy (i.e., sushi, deli meats, cheese). Drinking a lot of fluids doesn’t increase the amount of milk you produce. While you’re breastfeeding, you’ll If you think your baby is having a reaction to naturally be thirstier than usual. Listen to your body—you something you’re eating, read Breastfed babies don’t need to force yourself to drink a lot. However, if and allergies, page 574. you notice your urine is dark or cloudy, it means you’re not drinking enough. If you are a vegan (i.e., you don’t eat any animal There aren’t any foods that increase milk production. products, that is, meat, fish, eggs or milk products) Eat regularly and eat enough. You can also have snacks and you are breastfeeding, you should take a

if you’re hungry. Vitamin B12 supplement.

Milk Some foods can have a slight effect on the taste of the milk you produce, but your baby will adapt. Eat foods rich in protein, iron, calcium and Vitamin D. Some studies suggest that it can help babies develop It might be a good idea to consult a nutritionist. their taste for food if mothers eat a varied diet while breastfeeding. Feeding child your 388 soft drinks. soft chocolate, insome coffee,found and drinks, energy tea, is eliminatedCaffeine is the caffeine system. from his until make andirritable of it, it can your baby nervous passes If intoCaffeine you breast consumemilk. lot a drinks other and tea herbal chocolate, tea, Coffee, such as mercury, read from contaminants risk the minimizing while fish eating of and could harm ababy. To of take the benefits advantage that make pollutants absorb their way into milk breast Fish your on However, menu. belongs fish some species Fish Fish seafood and , page 88 , page . herbal tea can be good substitutesbeverages. caffeinated for good tea be can herbal beverages and such as drinks cereal-based Decaffeinated day. cups per so up to or two moderation, (coffee, products etc.), tea, Other maybe consumed in your baby. they containbecause other substances that might harm areEnergy not drinks recommended while breastfeeding 389 Feeding your child Milk Alcohol Breastfeeding mothers can enjoy the occasional alcoholic beverage. The benefits of breastfeeding outweigh the Any alcohol you do drink goes into your breast milk risks of occasional light alcohol consumption (around two and into your bloodstream. Depending on your weight, drinks a week or less). This level of consumption has not it takes your body two to three hours to eliminate the been shown to harm a nursing baby. alcohol from one drink from your blood and milk. Once the alcohol is gone from your bloodstream, there is none If you do have a drink, you can reduce your baby’s in the breast milk for the next feeding. exposure to alcohol in one of these ways: Even though a breastfeeding baby only receives a tiny • Breastfeed your baby right before having a drink. share of the alcohol his mother drinks, he eliminates it Or wait 2 to 3 hours per serving of alcohol before more slowly than an adult and his system is more sensitive • nursing again. After waiting, simply nurse normally to its effects. at the next feeding. Avoid drinking large quantities of alcohol while

Milk If you have more than one serving, feed your baby milk breastfeeding. Alcohol can interfere with milk production you expressed in advance (frozen or refrigerated) while the and reduce the amount of milk your baby drinks. It alcohol remains in your system. You may need to express may also have harmful effects on his motor development milk to relieve engorgement of your breasts, but this milk and sleeping habits. should be discarded because it contains more alcohol. Feeding child your 390 Size of a standard drink astandard of Size resources/alc_reduction/pdf/brstfd_alc_deskref_eng.pdf alcohol according to your weight, visit To takeseliminatehowto it out find long body for your and milk. and takes to eliminated 2to be your 3hours from blood 340 ml or 12 or ml 340 oz Each serving or glass or of an alcoholic beverage serving Each (5% alcohol) of beer

= 140 5oz or ml (12% alcohol) beststart.org/ of wine wine of

. = pure alcohol 1drink or =13.5 serving one In Canada, g(17 ml) of Good toknow Motherisk Helpline at to talk your health professional call the or breastfeeding, youIf have alcohol consumption questions about while of fortified wine wine fortified of (e.g., Port wine) wine) (e.g., Port (20% alcohol) (20% 85 ml or 3 oz 3oz or 85 ml

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1 ‑ 877 = ‑ 327-4636 . 45 ml or 1.545 or oz ml (40% alcohol) (40% of spirits of spirits

Illustrations : Maurice Gervais 391 Feeding your child Milk Tobacco Cannabis and other drugs Tobacco is harmful to your baby when you’re breastfeeding, Drug use and exposure to second-hand drug smoke just as it is during pregnancy. is not recommended during breastfeeding.

Tobacco can interfere with milk production. Nicotine It is not known what effect a nursing mother’s use of from tobacco also passes into breast milk and can cause marijuana and other cannabis derivatives might have crying, irritability and insomnia. Try to avoid smoking on her baby, but it is a source of concern. just before feeding. Other drugs, such as amphetamines, cocaine, heroin, Talk to your doctor if you are thinking about using LSD and PCP pass into breast milk and are dangerous pharmacological aids such as patches or nicotine gum for your baby. to quit smoking.

Even if you do smoke, breastfeeding provides many Milk benefits for you and your baby, including protecting him from respiratory infections. Feeding child your 392 recommend another product. It’s production. milk Decongestants containing pseudoephedrine including acetaminophen, ibuprofen and most antibiotics. Many may medications taken while breastfeeding, be babies. on nursing their effects about ismore known choice because are medications abetter Some amounts. small pass in medications into but very Most milk, breast Medications best to askbest your to pharmacist can reduce • • here’s what you do: can of amedication, because you to breastfeeding stop treatment. a health professional If of medical advises rare to because haveIt’s very to breastfeeding stop decrease your milk supply or cause other problems. may medications Some naturalor health product. Talk any to a health taking medication professional before

breastfeeding instead. breastfeeding to you andyour baby. is important Say that breastfeeding Ask if there are if anyAsk that taken medications while be can 393 Feeding your child Milk Exposure to contaminants If you work in an environment where you are exposed to contaminants like solvents, inks or dyes that may In Québec, environmental pollution is not generally be dangerous to your breastfed baby, you may be eligible a problem for breastfeeding mothers and babies. for reassignment or preventative withdrawal (see For a Safe Maternity Experience program, page 777). You can Breastfeeding mothers who come in contact with or also consult your doctor. breathe in chemical substances contained in household products may pass these substances on in small amounts to their babies through breast milk. This is only a problem in the case of regular and prolonged exposure, such as Handling expressed milk occurs at work. Before handling expressed milk, make sure your hands, In day-to-day life, exposure to the following products breast pump and accessories are clean. on an occasional basis is nothing to worry about:

Milk • At the hairdresser: hair styling products, dyes and perms Storing breast milk • At the dentist: local anaesthetic, fillings and root canals Breast milk is best when fresh and taken directly from the breast, but it refrigerates and freezes well, too. If you In the home: latex paint and varnish, home • only feed expressed breast milk to your baby, it’s preferable cleaning products to use freshly expressed or refrigerated milk. Prolonged freezing slightly reduces the nutritional value of breast milk. However, it’s still better than any other milk. Feeding child your 394 • • • are afew Here tips: it. expressing after as possible.it as You soon itstraight in put can the freezer refrigerator. you If don’t plan to itwithin use 8days, freeze later used itwill than be If that, keep itin4 hours. the kept be temperature at can up to for room refrigerator taken or of the out Milk expressed that has been just they are too fragile. up because doubled to be asare need well. too thin They anddon’t freeze commercial for liners formulas Baby bottle milk. for breast evenor designed liners in thicker special, baby bottle kept milkBreast be in can glass hard or containers plastic

it in the refrigerator untilit in the refrigerator you have the amount you want. they freeze. after to reduce waste. If youIf want to store alot of milk in asingle container, put fill Don’t past containers 90 ml) Save 30 and milk in different (between amounts 2 / 3 full. Liquids full. take space more milk Information on thawing milk found can be under to throwyou’ll need itout. otherwise feeding; more. or Use the next 4 hours itfor your baby’s You mouth. for keep itin can the refrigerator from with bacteria indiscard contact itunless ithas been yourup to but baby changes mind, you her don’t need thawed or warmed milk refrigerated the fresh, If has been • • • •

a larger, tightly closing container. to avoid temperature. in changes Use the oldest milkUse first. the oldest You all put your can frozen milk breast containers inside Store away milk in the door of the the back freezer from the dateMark the container on ittightly. andseal , page 501, page . Warming 395 Feeding your child Milk Breast milk storage time

Room temperature Refrigerator Freezer*

Fresh breast milk 4 hours at 26°C (79°F) 8 days at 4°C (39°F) 6 months (refrigerator 24 hours at 15°C (59°F) freezer, but not in the door) (in a cooler with ice pack) 12 months (chest freezer)

Previously frozen breast milk 1 hour 24 hours Do not refreeze

* The freezer temperature must be cold enough to keep ice cream hard (-18°C or 0°F).

Milk The storage times in the table above don’t always apply Warning for hospitalized babies. For hospitalized babies, follow Storage times can’t be added together. For example, the recommendations of the hospital staff. you can’t keep milk for 4 hours at room temperature, then put it in the refrigerator or freeze it. Feeding child your 396 • • • • can vary or brownish colour tinge. milk andsmell of breast The Human milk have can awhitish, bluish, yellowish Warm ashake milk needs to just ittogether again. mix awhile andthe creamto the floats surface. it separates after commercial infant Since formula. it’s not homogenized, like milk breast doesn’t look cow’sExpressed milk or milk Appearance expressed of

at the beginning or the end of afeeding the end at the beginning or Depending on whetherDepending the milk was expressed on theDepending baby’s age According to the mother’s diet From to mother one the next

one time to the next and from one mother to mother one another. andfrom time toone the next amount of creamout—it’s still The from varies good! Don’t throw and the creamto it floats the surface. Expressed breast milk separates after a while a while milk breast separates after Expressed

Cécile Fortin 397 Feeding your child Milk The smell and taste of some mother’s milk changes when Commercial infant formula the milk is refrigerated or frozen. This is caused by lipase, an enzyme that helps babies digest fats. The digestive (commercial milk) process can begin while the milk is still in its container. Don’t worry—it’s still good for your baby. The Canadian Paediatric Society, Dietitians of Canada, and Health Canada recommend that babies not fed Some babies don’t like the taste of refrigerated or frozen on breast milk be given iron-enriched commercial infant milk and refuse to drink it. Sometimes you can solve the formula up to the age of 9 to 12 months. problem by freezing your milk without refrigerating it first. When properly prepared, commercial infant formula If that doesn’t work, try is a safe alternative to breast milk. Unlike cow’s milk, goat’s milk and soya drinks, commercial infant formula is adapted Heating it to just below the boiling point • to meet infants’ basic needs. • Then, cool it off immediately

Milk Pay attention to the expiration date: don’t buy formula And freeze it • if the date on the can has passed. Return any dented, bulging, or abnormally shaped container to the store. This will deactivate the lipase Feeding child your 398 and can even be misleading. even be can and to baby are your benefit of no They sales. there to boost are labels only milk. Additives andclaims product listed on that than or the others itis closer tois better mother’s representative sales Each will say that their product extensively nurses, to and nutritionists. parents, doctors, their products Companies advertise formula is the best. parentsMost wonder what brand of commercial infant birth. from right formula iron-enriched To prevent choose? formula to Which anemia , it is recommended babies be fed fed be babies , itis recommended too often. too thisIf is with your the case baby, avoid changing brands few days. by during especially the first it, bothered be can babiesMost have no problem changing brands, but others comparable in quality. in comparable another.than are formulas Commercial infant To date, that is there is better brand proof no one 399 Feeding your child Milk Ready-to-serve, liquid, or powdered Characteristics of the different forms of commercial Commercial infant formula is sold in three forms: infant formula

• Ready-to-serve Ready-to-Serve • Concentrated liquid • Sterile at time of purchase. • Powdered • Easiest to use. • Is used as is. The same brand of formula may look different in • Very expensive. its ready‑to-serve form than it does when prepared from concentrated liquid or powder, but the composition Concentrated liquid and nutritional value remain the same. • Sterile at time of purchase. You can use any of these forms or alternate depending • Easier to use and safer than powdered form.

Milk on the situation, (e.g., at home, on an outing). However, • Must be diluted with water. ready-to-serve and concentrated liquid baby formulas • Costs about the same as powder. are preferred for premature, immunocompromised, and low-birth-weight babies because they are sterile at the Powdered time of purchase. • Not sterile at time of purchase. • Greater risk of contamination because it requires more handling. • Requires greater care during the dilution step than concentrated liquid. • Costs about the same as concentrated liquid. Feeding child your 400 more expensive than expensive cow’smore milk. much but formula, commercial than infant cheaper are 12 age babies for products to products 36 months. These market 6months babies for andover. are even There is of commercial arange There infant formulas the on “Transition” formulas product. it is a ready-to-serve of giving your baby undiluted concentrate, thinking variety. you If do, you the risk run with the ready-to-serve It is to easy confuse concentratedproduct. liquid formula to make carefully the label Read sure the desired you buy under 6 months because itcontains 6monthsunder because too much calcium. “Transition” formula babies is for not suitable excessive crying in infants. in excessive crying reduce not does formula infant However, soy-based using health problems. with certain babies for or products families don’t whose consume babies is suitable for dairy protein soy from made formula infant Commercial Soy-based infant formula a nutritional than point of view cow’s milk. from transition diet, eat formula is better who no avaried around of 9to the age 12 months. For over babies 9 months cow’s your baby milk feeding until you start formula regular theybut are not necessary. You continue can using your alternative acheaper 6to be age can babies 12 for months, products transition to formula, commercial infant Compared 401 Feeding your child Milk Special infant formulas Handling commercial In rare cases, babies fed with a commercial infant formula infant formula may have trouble tolerating formula. Talk to a doctor if this seems to be the case. The doctor can recommend Diluting commercial infant formula requires care a special formula for your baby. and certain precautions. It is important to avoid mistakes so as not to contaminate the milk with bacteria. Special formulas are intended for babies with specific problems, such as allergies or severe intolerances. Medical Among the different types of commercial formulas, insurance plans reimburse the cost of certain products powdered products require the most care because when purchased with a prescription. they are not sterile and may contain bacteria. Bacteria may get into powdered formula at the factory where If your baby has trouble tolerating commercial infant it was manufactured, or at home when you use formula, you can also go back to breastfeeding the container and the measuring scoop provided. (see Restarting milk production, page 451).

Milk Some babies have gotten sick after drinking milk made from powdered formula contaminated with bacteria.

To avoid contamination, you can do two things: • Destroy bacteria • Prevent bacteria from developing and multiplying Feeding child your 402 the manufacturer’s directions. the manufacturer’s eventhe WHO recommendations, from they if differ tothan 30 minutes after follow It boiling. is preferable To ensure the water is itwithin use hot enough, less to 70°C formula. to or higher powdered prepare water using cooled has recommended boiled (WHO) hot water.using very World The Health Organization To destroy bacteria if you wish. developing, although you can also destroy bacteria itis sufficientin good health, from to prevent bacteria preparing powdered formula. For term babies who are when to destroy itis bacteria recommended babies, low and For premature, immunocompromised, , prepare the infant formula formula infant the prepare , ‑ birth ‑ weight weight of 24 hours. kept also amaximum can at be for in 4°C the refrigerator itimmediately.serve Formula that’s in advance prepared totemperature. it’s best Once the formula is prepared, to water room cooled thatformula with boiled has been To prevent from bacteria developing cold water. Until yourand bacteria. baby is 4 months boil old, itis likely more tobecause contain contaminants, lead, Never water hot use tap to infant prepare formula , prepare the infant infant the prepare , 403 Feeding your child Milk First step Second step For all types of formula Depending on the type of formula

Here’s how to prepare infant baby formula. Regardless Concentrated liquid Powder Ready-to-serve of the type of formula you use, the first step is always Note: Follow the manufacturer’s directions to the letter regarding the quantities of the same. powdered formula and water to use.

For babies under 4 months: For babies under 4 months: • Pour the formula into the baby bottles. • Clean the work surface. • Fill a saucepan with cold tap water. • Fill a saucepan with cold tap water. • Immediately put the nipples • Wash your hands thoroughly. • Bring to a rolling boil for one minute. • Bring to a rolling boil for one minute.* and caps back on the bottles. • Sterilize and assemble all the required equipment • Mix equal quantities of boiled water and concentrated • Pour the recommended quantity of water into the baby bottle or other container. • If any ready-to-serve formula and utensils.* liquid formula. • Measure the powdered formula with the measuring scoop provided; scoop size varies remains in the can, cover the • Clean the formula container with hot water before • Stir to mix well. from one brand to the next. can and put it in the opening it with a clean can opener. • Cool the mixture rapidly in cold water before putting it in • Add the required quantity of powdered formula to the water. refrigerator. Milk the refrigerator or feeding it to your baby. • Stir to mix well. * For additional information on sterilizing and using baby bottles, see Cleaning bottles, nipples and breast pumps, page 507. • If any concentrated liquid formula remains in the can, cover • If needed, cool the mixture rapidly in cold water before feeding it to your baby or the can and put it in the refrigerator. putting it in the refrigerator. • Wash the measuring scoop and put it away in a sealable bag or clean container to protect it from dust. Do not put it back in the can in order to avoid contamination.

For babies 4 months and over: For babies 4 months and over:

• Follow the same directions, but you can use cold, • Follow the same directions, but you can use cold, unboiled tap water. unboiled tap water.

Feeding child your * To know what temperature of water to use when preparing powdered formula, see page 403. 404 • over: and 4months babies For • • • • • • 4months: under babies For Concentrated liquid of formula on type the Depending step Second unboiled tap water. unboiled refrigerator. the in it put and the can cover can, the in remains formula liquid anyIf concentrated baby. to it your feeding or the refrigerator it in putting before water cold in rapidly mixture the Cool Stir well. to mix liquid formula. concentrated and water boiled of quantities equal Mix minute. one for boil to arolling Bring water. tap cold with Fill asaucepan Follow the same directions, but you can use cold, cold, use can you but directions, same the Follow

* • over: and 4months babies For • • • • • • • • 4months: under babies For to use. water and formula powdered Note: Powder To know what temperature of water to use when preparing powdered formula, see see formula, powdered preparing when touse water of temperature To what know protect it from dust. Do not put it back in the can in order to avoid contamination. order in can the in back it put not Do dust. from it protect to container clean or bag away it asealable in put and scoop Wash measuring the refrigerator. the in it putting or baby to it your feeding before water cold in rapidly mixture the cool needed, If Stir well. to mix water. to the formula powdered of quantity required the Add next. to the brand one from varies size scoop provided; scoop measuring the with formula powdered the Measure container. other or bottle baby into water the of quantity recommended Pour the minute.* one for boil to arolling Bring water. tap cold with Fill asaucepan Follow the same directions, but you can use cold, unboiled tap water. tap unboiled cold, use can you but directions, same the Follow Follow the manufacturer’s directions to the letter regarding the quantities of of quantities the regarding letter to the directions manufacturer’s the Follow page 403 page . • • • Ready-to-serve refrigerator. the in it put can and cover the can, the in remains formula anyIf ready-to-serve bottles. the on back and caps nipples the put Immediately baby bottles. into the formula Pour the 405 Feeding your child Milk Always check the expiration date before giving Most babies have no problem if a mistake like this is only commercial infant formula to your baby. made once or twice. If it happens more often, it can cause digestive or kidney problems, dehydration, or insufficient weight gain. If you are worried or your baby seems sick, If you make a mistake when preparing see a doctor or call Info-Santé (8-1-1). the mixture (dilution error) If you mix the wrong quantities of commercial infant formula and water, don’t panic. First, observe your baby. Does he seem uncomfortable?

How long does commercial infant formula keep?

Room temperature Refrigerator Freezer Milk Milk reconstituted Maximum 2 hours 24 hours Do not freeze from concentrated liquid Close the can properly or powder

Open can of liquid Maximum 2 hours 48 hours Do not freeze formula (concentrated liquid or Close the can properly ready-to-serve)

Open can of powder 1 month if kept dry Unnecessary Do not freeze Feeding child your 406 Marie-Christine Hogue 407 Feeding your child Milk Milk Feeding child your 408 doesn’t provide the immune protection of mother’sdoesn’t provide the immune milk. protection and it like andalpha-lactalbumin, taurine, cysteine, It deprives your baby protein of important building blocks B A, vitamin not contain it does In addition, andbrain. enough system required for the development of your baby’s nervous acid acid, linoleic afatty or lactose not provide enough minerals baby’s for to handle. kidneys Cow’s milk does itcontains because tooold much protein andtoo many Cow’s milk never should given be to 9 months ababy under Cow’s milk O under 9 months old. ther types of milk of types ther Cow’s milk is completely unsuitable infants for 1 , B 6 , C, D,, C, copper, andE, manganese, iron. or whole milk (3.25%whole milk fat). than not more but 750milk, ml (25 oz) aday. pasteurized Buy 9months After for. apply can financial you assistance about yourformula is information for CLSC too expensive, contact commercial 9months because of age infantbefore age youIf are cow’s of giving thinking milk to your baby invisible is to often lightThis the naked eye. bleeding in the intestine. cause bleeding andcan of other foods, iron, reduces intake little itcontains because very 9months Before – You your giving baby cow’s start can – Cow’s causes milk often anemia

409 Feeding your child Milk Introducing cow’s milk If you give cow’s milk to your child, choose whole milk (3.25% milk fat): Your child can start drinking cow’s milk at 9 months, providing she eats a varied diet. Every day she should eat • Ordinary homogenized milk, enriched with vitamin D • Iron-rich foods (e.g., meat, meat alternatives, or iron‑enriched baby cereals) • Unsweetened evaporated milk, enriched with vitamins C • Vegetables and fruit and D, diluted in an equal quantity of water

Otherwise, wait till your baby is 12 months old before Cow’s milk can be introduced gradually. You can begin introducing cow’s milk. by replacing some of the breast milk or commercial infant formula with cow’s milk. Then you can gradually increase the proportion of cow’s milk at each feeding. Milk Feeding child your 410 Never serve sweetened concentratedNever sweetened serve milk. your child throughout early childhood, up to age. school You milk (3.25% whole continue can milk fat) serving to 1% them not serve Do milk. 2. age before skimmed or to avoid It’sdevelopment. 2% better them giving milk Young andbrain growth for fat children need milk 2% skimmed or serve not Do are also allergic to goat’s milk. childrenreactions. Many are who allergic to cow’s milk Unfortunately, causes the same goat’s milk often or treating allergies to the proteins in cow’s milk. recommend people goat’sSome milk for preventing goat’s milk (3.25% whole pasteurized Choose milk fat). of 9and12 the ages milk to your child between months. goat’s Like serving stores. cow’sgrocery you start can milk, milk Dis withacid folic andvitamin available enriched at It is also lowmilk. in D, acid folic andvitamin although goat’s For goat’s milk as infants, cow’s disadvantages has the same Pasteurized goat’s milk 411 Feeding your child Milk Enriched soy drinks Some parents want to serve soy drinks to younger children. You can give your child soy drinks after 1 year Enriched soy drinks are not suitable for infants. They of age, as long as she eats a varied diet and is growing are incomplete and much less nutritious than breast milk normally. Make sure that the soy drink you choose for your or even commercial infant formulas. Since babies grow 1 to 2 year old has the following terms listed on the label: very rapidly, they need a complete, balanced diet. These drinks can hinder your baby’s growth. • “Enriched,” because drinks that are not enriched do not provide enough nutrients to meet the needs Soy drinks contain fewer calories and less fat than whole of a young child cow’s milk (3.25% milk fat). This is why it is recommended that you wait till your child has reached 2 years of age • “Plain” or “Original,” because “light” or flavoured drinks before serving her soy drinks. are not suitable

Shake the drink container well (around fifteen times) before serving to make sure the nutrients are well mixed, Milk especially the calcium. Feeding child your 412 and poses no risks to your child’s risks no and poses health. stores is as just nutritiousmilk sold in food as raw milk diarrhea, salmonella and brucellosis. pasteurized The including poliomyelitis, encephalitis, typhoid, tuberculosis, through raw milk, transmitted unpasteurized or be can milkof unpasteurized is Many in illegal Canada. diseases the sale It is essential to In animal fact, pasteurize milk. milk Why pasteurized serve even if the milk comes from a perfectly healthy herd. even the milk if aperfectly comes from Do not giveDo raw (unpasteurized) milk to your child, D, acid. andfolic milk’s of loss natural at home. It is too slow,causes and significant less effective, to milk pasteurize that It is you recommended not try milk remainsunchanged. the of value nutritional the and destroyed are microorganisms Dangerous rapidly.it equally process takes only The afew seconds. high temperatures, cooling andthen to very very rapidly consists of heatingIndustrial pasteurization the milk nutrients : vitamins A, B : vitamins A, 1 , B 2 , B 6 , B 12 , C, , C, 413 Feeding your child Milk 414 Feeding your child Breastfeeding your baby Breastfeeding problems and solutionsBreastfeeding Weaning bottle and breast Combining milk Expressing still possible? breastfeeding Is phases Breastfeeding to nurse—and how long? How often by step step Breastfeeding, Your breasts during nursing helpGetting A learned skill Breastfeeding: ��

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René Dery between you and yourbetween baby during pregnancy. started that relationship the sustains Breastfeeding temperature. your his baby stabilize body andhelp will time soothe of nursing the first delivery, for the act your baby snugglesAs up to your right breast after A learned skill Breastfeeding: information on the precautions you should take. Info-Santé youIf have COVID-19 call andyou wish to breastfeed, under be found can start off good to a to get milk production how itis andhow produced milk, Information breast on express In this chapter, you’ll find howinformationon breastfeed, to Mother’s milk Mother’s milk, use a breast pump andwean abreast use your infant. milk, (8-1-1 ) or consult) or ahealth professional for , page 385, page . Breastfeeding promotesBreastfeeding a closer mother-child bond.

Louis Guilbault 415 Feeding your child Breastfeeding your baby Breastfeeding, like giving birth, is totally natural. Learning to breastfeed is a little like learning to And just as it’s normal to have assistance during delivery, dance. At first, you focus on your steps, not the music. it’s normal to need help with breastfeeding, especially But with time and practice, you forget the technique at the beginning. While your milk will come in on its own, and the music carries you away. you will need to learn how to breastfeed.

The first days with a new baby are an intense experience. Your baby will need frequent attention and will nurse Getting help at any time of day and night. There are many resources for breastfeeding mothers. The initial weeks of breastfeeding are critical because Depending on where you live, you may be able to find they are a time of adaptation and learning. Mastering IBCLC lactation consultants (International Board Certified the technique of latching the baby to your breast is Lactation Consultants) or clinics or doctors that specialize your first priority. Give yourself plenty of time, and have in breastfeeding. You also might discover that your

Breastfeeding baby your confidence in yourself and your new baby. local CLSC or local breastfeeding mentor group has the best-trained breastfeeding resources in your area. As you gain experience, getting your baby to latch onto the breast will become easier. With time, you and your If you encounter problems, it’s important to contact a little one will come to enjoy the nursing experience more person trained in breastfeeding. If that person can’t help and more. you, she will be able to suggest other resources that can. Feeding child your 416 and help you with breastfeeding technique. youand help with breastfeeding weigh She can youron. baby, overall her check health as you you helping later as or home, return soon start can Yourare either automatic your on needs. based or nurse baby arrives. on where Depending you live, these visits your visits after home offer of help. also Nurses can be Various available. information. your contact for CLSC Ask withCheck organizations in your area towhat’s out find IBCLC from consultants. services lactation specialized Aprepare number of for them breastfeeding. also offer information sessions to help parents and parents-to-be groupsat charge. no community hold of these Most and offer support They keep their up-to-date knowledge byhave children. who more women or led one nursed a great deal of information are andadvice. and run They Community groups support breastfeeding CLSC professionals —like nurses or nutritionists— nutritionists— —like or nurses can provide diplômées de l’IBLCE) de diplômées consultantes des (Association québécoise lactation en the IBCLC consultant you, nearest visit the AQC website offices. or their homes either from more orfind learn To consultants. Manylactation are of them in private practice of IBCLC groupsservices offer the support breastfeeding healthcare institutions Some skills. and community Consultant—certifies that they haveLactation necessary the The IBCLC International credential—for Certified Board difficultiesbreastfeeding that you experience. may An the province. call Just and is available 24 aday, hours throughout 7days aweek, The IBCLC lactation consultant consultant IBCLC lactation Info-Santé Info-Santé telephone helpline is staffed by nurses 8 ibclc.qc.ca/en ‑1 ‑1 . can help you help dealcan with . 417 Feeding your child Breastfeeding your baby Breastfeeding clinics can be found in many areas. Your breasts during nursing They offer more specialized services—from nurses, IBCLC lactation consultants and sometimes doctors—which may or may not be free. Clinics can be very helpful if you Breast and nipple shape are experiencing problems. Breast and nipple shape, size and colour vary from one woman to another, and sometimes even from one breast Your doctor will examine your baby on a regular basis. to the other. Most newborns adapt easily to their mothers’ If you’re worried about your child’s health, the best person breasts. For unknown reasons, however, there are some to turn to is your doctor, who can also help if your breasts babies who have more difficulty latching onto flat or or nipples become infected. inverted nipples. Midwives provide followup for their patients up to six weeks after delivery. Breast care The breasts are often bigger and heavier during the first

Breastfeeding baby your If you have special problems, all of these individuals six weeks of breastfeeding. Whether or not you choose should be able to direct you to other sources of help. to wear a bra depends on your comfort. Nursing bras are usually more practical than regular bras, but you don’t have to wear one. Regardless of what you choose, your bra should be comfortable and large enough to avoid squeezing your breasts. Don’t hesitate to sleep barebreasted if you feel comfortable doing so. Feeding child your 418 become larger.become increases rapidly. also women find that Most breasts their the appearance of the milk changes andproduction delivery. days after and fifth warmer, become breasts Your the It second generally production. happens between Having your milk “come in” of milk phase is anormal yourWhen in comes milk way nursingwater is the to best before prevent infections. are not necessary. Washing your and hands with soap Creams,breasts clean. ointments and other products A daily shower bath to or is keep all your you need them often. lining aplastic sureones without andbe to change disposable or cotton you choose If nursing use pads, advice in the table entitled advice in the table painful? become is too or firm, breasts your You’ll find latchingbecausethe breast has What he if difficulty on himand help gain weight. this phase, in your which will breasts ease the discomfort Your during babywant will to generally often more nurse day both at regular intervals, andnight. (8 times or more during are a period) 24-hour recommended from 24 to thorough hours, 48 and frequent feedings the touch. To lasts which generally ease the discomfort, andfirm to engorged become their if breasts especially uncomfortable, be itcan women comes most for But in. womenSome no experience discomfort their when milk Engorgement , page 492, page . 419 Feeding your child Breastfeeding your baby Producing a good supply of milk Some women produce substantial milk without much stimulation, even if breastfeeding was difficult Milk production is a matter of supply and demand. for them at the start. For others, however, milk production The more your breasts are stimulated, the more milk can be less reliable, decreasing as soon as stimulation they’ll produce. lets up or becomes more infrequent. A person trained in breastfeeding can often help new mothers increase To get milk production off to a good start during the first milk production, especially during the first weeks few days (see Insufficient milk production, page 480). • Nurse your child or express milk within 6 hours of delivery to stimulate your breasts Let-down reflex Nurse your child or express milk at least 8 times during • Stimulating the breasts also results in the release of a 24-hour period, with no more than 6 hours between oxytocin into the bloodstream. Oxytocin is a hormone • Express your milk if your baby isn’t sucking effectively that causes the breasts to contract and expel milk. This

Breastfeeding baby your or latching on properly. During the first few days, is known as the “let-down reflex.” expressing manually is often more effective than using a breast pump

Milk production fluctuates during the first 4 to 6 weeks, depending on demand. That’s why it’s important to stimulate the breasts during the day and at night during this phase. Feeding child your 420 even notice spurts during reflex. the let-down even notice spurts Women the pace milk quicken expressing see can and to to of the breast go take let abreathwill need of air. strong that so is baby reflex your the let-down Sometimes several for will minutes. swallow quickly and babies more During the milk let-down reflex, flows more rapidly reflex. with the let-down intense thirst and uterine contractions in conjunction delivery, few days the first after you mayexperience During no sensation. or tingling feel others in the breast; a tightening30 seconds to feel 2minutes. women Some from last results typically times while nursing. The several It’s not unusual reflex the let-down to experience nursing. begins It ensures that milk available will be your baby when too. reflex, the let-down him trigger can about thinking or your hearing Just baby cry milk. expressing when to your you if or stimulate breast, and the nipple put babywhen you your mightbe triggered reflex This areola

if it takes acouple of triesto latch on. way patient more she’ll andcooperative, be especially breast offer her your signs as you see that yourAs soon baby is hungry, to nurse. It’s hard to is crying ababy or who upset get Pick right the (signs time of hunger) it. you if help need effectively.can provide trainedperson inbreastfeeding A what and toexplaining your so do child properly nurses will guide you by step step, section This their own style. immemorial, and each nursing mother and child discover since their babies time have breastfeeding Mothers been by step step Breastfeeding, (see Hunger signs , page 367) . That That . 421 Feeding your child Breastfeeding your baby Find a comfortable position Give yourself plenty of time for your first breastfeeding sessions. Take a few minutes to make sure you’re comfortably settled. There are various positions, so choose the one that feels best for you: cradle, cross-cradle, football or lying down. Whichever you choose, your baby’s whole body is turned toward your breast, with her ear, shoulder and hip forming a straight line.

Cross-cradle position With a newborn, the cross-cradle position offers two advantages: it allows you to properly support your baby and to clearly see how she latches on (see picture

Breastfeeding baby your page 424). Many mothers find it useful during the first weeks of breastfeeding.

In this position, the baby rests on the arm opposite the breast she is nursing from. If you are nursing from the right breast, you support your baby with your left arm.

Anouk Jolin Anouk Hold your baby in place against your breast by supporting his bottom with your forearm. A comfortable chair, music, cushions or pillows and a glass of water or milk will help you relax. Feeding child your 422 stays safe. recommendations If you tend to while nursing, doze follow the sleep or really like this once position latching easier. becomes on can promote rest down is enjoyable while lying and Breastfeeding Lying-down position (see picture a“U” forming fromand on nipple the farinner the side, fingers the outer on site rest should andthe other of the breast your rightHold with your breast right Your hand. thumb latching this readjust If your happens, on. back position. mayThey draw andsome their back heads have difficulty to like palm of youror the don’t seem Babies hand. this. Avoid pressure with your the head on fingers putting (as the head not behind shown in the photos). hand should placed be beneathleft his shoulder blades, palm of movement.your The freedom allows some for the weight of your baby’ssupport in away head that still Yourexceptionwith the of fingers, the thumb, should (see picture page 425)(see picture on page 295 page on page 435page to make sure your baby ). . Most mothers mothers Most . areola , Yes No

Marie-JoséeCécile Fortin Santerre 423 Feeding your child Breastfeeding your baby Cross-cradle position Cradle position Breastfeeding baby your René DeryRené Jean-Claude Mercier Feeding child your 424 Football position

Jean-Claude Mercier Lying-down position

Jean-Claude Mercier 425 Feeding your child Breastfeeding your baby Bringing baby to your breast You’ll need to coordinate your movements with that of the baby as she opens her mouth. It’s the baby who Whether you choose a seated or reclining position, latches onto the breast, but you must bring her close make sure that your baby latches on to more than just to it at the right moment. You’ll be more comfortable the nipple; she should also be taking much of the areola, if you don’t lean toward the child. adjacent to the nipple, in her mouth. During your baby’s early weeks, feeling the breast near If your baby reaches for the breast at this point, her hands her mouth stimulates the sucking reflex. If your child sees may end up in her mouth before your breast does. If this your breast but doesn’t sense it against her face, she will happens, ask the child’s father or someone else close to probably not open her mouth very wide. Bringing her you to gently hold the baby’s hands. As soon as she latches close enough so her chin grazes your breast will probably on and starts sucking, you’ll see her hands relax. make her open her mouth more willingly.

Breastfeeding baby your With your help, your baby will learn how to latch on and will soon be almost able to do it alone. Feeding child your 426 1 2. 1. to your breast: you’re ready to your bring baby Once of you both are settled, How tobringyour baby toyour breast her upper lip.her upper against nipple your brush gently When her chin her touches When your breast, a bite of alarge out apple. as were she if to going take yawn or Wait wide, mouth till her opens she 2 • • • 3.

palate, not her tongue. lip. upper the near with nipple the very first, breast atinyjust bit. Her lowerHer lip should touch your Your nipple should point toward her tilted backwards be should head Her palm of your hand: palm of her shoulder blades with the baby to supporting the breast, At your this bring quickly point, 3 will become easier. will your baby will andeverything learn practice, But with in the beginning. for you. Latching time takes on a little painful be to can This the breast. or completely partially getting before mouth might close her sometimes your baby to latch properly. on She overhave several times to get to start few days, the first During mayyou

Jean-Claude Mercier 427 Feeding your child Breastfeeding your baby Latching on Signs of a good latch: When your baby latches onto your breast, and not only the • The baby’s mouth is wide open. nipple, he will have a large part of the areola in his mouth. He latches onto not only the nipple only but also a large This makes it easier to get milk. • part of the areola. If the baby sucks mainly on the nipple, painful cracks • His lips are curled outward. may result and he will get less milk. Some babies will then His lower lip covers a larger part of the areola than the ask to nurse more often, which will irritate the nipples even • top lip does. If needed, gently press your breast to reveal more. Others will get tired and fall asleep before they’re full. the lips. • His chin touches your breast and his nose is free. • You can hear or see him swallow.

Breastfeeding baby your Latching on shouldn’t be painful for you. Feeding child your 428 baby swallow. baby slowerbecome anddeeper. You andhear your see can flowing,movements the are quick milk andlight. starts As movementsto nurse, the in the jaw.starts first she When effectively, motion yoursee babycanWhen sucks you your effectively if babyHow tell to sucking is trained incontact someone breastfeeding. lip once he’s that nursing. If doesn’t pain work persists, or gentlycan lower your baby’s chin to repositionhis lower You to improve also can try the latch. you cases, In some bringing the baby to your again. breast pain, try youIf feel on properly is the key to pain-free nursing! is the keyon properly to pain-free the latch. Latching painful. Nursing shouldn’t be If you experience painful nipples, try to improve to improve try nipples, painful experience you If

Marie-Josée Santerre 429 Feeding your child Breastfeeding your baby If your baby’s breathing is noisy during nursing, free up her nose by pressing her bottom against you to bring her chin closer to your breast. Don’t worry, she won’t suffocate. If she has trouble breathing she will release the breast. In some cases, you might need to press gently on your breast with your finger to free up her nose.

Breaking the suction It’s important to break the suction properly when removing your baby from your breast, to avoid hurting 1 your nipples. To break the suction 1. Put your finger in the corner of your baby’s mouth

Breastfeeding baby your between the gums, if needed

2. The nipple will release easily once the suction is correctly broken Marie-Josée Santerre

Feeding child your 2 430 431 Feeding your child Breastfeeding your baby How often to Giving your baby commercial infant formula or baby cereal results in less stimulation for your breasts and nurse—and how long? may interfere with milk production.

How often you nurse varies a great deal from one baby Does your baby seem satisfied after nursing, only to to another. What’s important is that your baby latches seek your breast 15 or 20 minutes later? That’s completely on properly, nurses effectively and swallows your milk. normal, especially during the first weeks. Don’t hesitate to nurse again for a little “dessert”. Mother’s milk is rapidly digested, and infants’ stomachs are small, so it’s normal to breastfeed frequently during the first weeks of life. When you’re at the learning When you’re breastfeeding, don’t watch the stage, the process of nursing, stimulating, burping clock—watch your little one. Trying to nurse on a and diaper‑changing can take from 45 to 90 minutes. schedule won’t protect against irritated nipples With time, as your baby develops the ability to nurse and could deprive your baby of needed nourishment.

Breastfeeding baby your more effectively, breastfeedings will become shorter Better to watch your baby for signs of hunger and less frequent. and satisfaction!

During growth spurts, your baby will nurse more frequently during the day and at night—sometimes as often as every hour. Frequent breastfeeding increases milk production. This is a passing phase, but it’s a very intense one for moms. Family support can be very important during these periods. Feeding child your 432

publications.msss.gouv.qc.ca/msss/sujets/allaitement Download our guide at: Adapted and revised on October 2017 with permission from the Best Start Resource Centre. On average over 24 hours Colourof Stools Diapers of Soiled Number On average over 24 hours Diapers ofNumber Wet On average over 24 hours Number of Feedings Tummy Size Your Baby’s Average Your Baby’s Age

BLACK OR DARK GREEN At least least At 1 WET 1 DAY 1 Size of a cherry At least 1 to 2 to 1 least At

At least least At 2 DAYS 2 2 WET

For NursingFor Mothers Fact Sheet At least least At 3 DAYS 3 3 WET Size of a walnut BROWN, GREEN BROWN, GREEN OR YELLOW At least 3 least At

At least least At 4 DAYS 4 4 WET

Your baby sucks vigorously and swallows often 8 times or more per day 5 DAYS 5 Size of an apricot 6 DAYS 6 HEAVYPALE WET WITH YELLOW At least 3 large, soft and seedy 7 DAYS 7

At least 6 least At YELLOW

2 WEEKS or Size of an egg CLEAR URINE 3 WEEKS 433 Feeding your child Breastfeeding your baby Cluster feeding Your baby might nurse from one breast or both during a feeding, and you should go along with his preference. Feedings are more frequent at certain hours of the Let him nurse from the first breast until he’s full. When day and less frequent at other times. Evenings can be a he starts to let go or becomes drowsy, try burping him. challenging time because most babies tend to get cranky Then offer the other breast: he’ll take it if he’s still hungry. and nurse a lot. They sleep a bit, cry a bit, nurse a bit and need comforting. Some babies may want to nurse You can change breasts more than once during a feeding. almost non-stop for a few hours. They may then sleep Some babies release the breast as the flow of milk slows. for longer periods. “Cluster feeding” is normal, although Offering the second breast gives the milk glands in the it can leave you with the impression you don’t have first breast a chance to refill. If your baby isn’t full after enough milk because your breasts are soft and have less nursing at the second breast, he can return to the first time to produce new milk. one. And if he’s still hungry, change once more to give him the second breast again. One breast or two? Or more?

Breastfeeding baby your At the next feeding, start with the breast that was offered The number of times that your baby will want to change last or the one your baby nursed from least. If you don’t breasts during a feeding will depend on remember, offer the breast that feels heavier. • The quantity of milk accumulated in the breast • His appetite and age • The time of day Feeding child your 434 should not be painful or stretch the areola. the stretch or painful be not should This moving hand your without with your fingers. whole with your the breast baby’snot interfere Squeeze sucking. other. Keep your fingers awayfrom the with your on thumb sidethe andyour one on fingers With your hand, make at of the breast, aUshape the base technique. this for best is position cross-cradle The few dayscolostrum during the first of life. way to your good get baby drinking It’s also avery • • • • actively.more Use this technique your if baby It increases milk flowneeds. and babykeeps your nursing enough milk get the to he baby doesn’t effectively nurse compressionBreast is atechnique you your if use can compression Breast

Seems dissatisfied Seems periods long for or Wants often to very nurse weight enough gaining Isn’t Falls nursing when quickly asleep areola so as so to more effectively. nursing starts baby your once technique this using Stop needed. breast—and again—if first one second the way if your to baby want seems You it. to return can the same breast in other the the Offer swallowing. he stops again, continuing until start then as stops drinking, he baby continues the pressure Release swallowing. as soon Maintain pressure 5to for 10 as as or your seconds long

Jean-Claude Mercier 435 Feeding your child Breastfeeding your baby Pacifiers (soothers) The Canadian Paediatric Society makes the following recommendations about pacifiers: A crying baby is trying to tell you something. He may need food, sleep, comforting or contact; it’s not always • ”It’s best not to start using a pacifier until breastfeeding easy to know exactly which. is going well. Talk to your doctor or lactation specialist if you feel your baby needs to use one at this early stage. Breastfeeding is more than a way to provide your baby One exception is for premature or sick babies in the with nourishment. Don’t worry; letting your baby nurse hospital who can benefit from using one for comfort.“ for comfort won’t create bad habits. In many cultures, ”Always see if your baby is hungry, tired or bored before breastfeeding is used as much to calm infants as it is • giving him the pacifier. Try solving these things first“. to nourish them. Babies also find the warmth of skin-to-skin contact with their fathers soothing. Rocking or carrying your baby in your arms is another great way to provide

Breastfeeding baby your comfort and reassurance. Feeding child your 436 to easier get with time. clearly. andmore seems more theirstate needs Everything children get older, their behaviour changes too—they’ll As baby’s fluctuates supply in response her to needs. A nursing woman’s breasts undergo changes as her milk phases Breastfeeding important needs. important many him meet andhelps of his arms comforts Breastfeeding with your in baby your snuggled Breastfeeding

Mireille Lewis 437 Feeding your child Breastfeeding your baby The table below provides an overview of breastfeeding phases between birth and the age of 6 months, describing your baby’s behaviour and what may happen at feedings.

Right after birth: Mother and child get acquainted The first 14 days: A time of learning for mother and child

Your baby Your baby • Will instinctually seek your breast within an hour of birth. • May be drowsy, especially if she is jaundiced. • Will then sleep for several hours. • May sleep so much that you need to waken her up • May find it harder to breastfeed if she has taken more time to ensure she gets enough nourishment, i.e., 8 times to recover from delivery. or more per day (24 hours). • Tends to fall asleep at your breast as soon as the flow of milk slows, even if she hasn’t drunk enough.

Feedings Feedings Breastfeeding baby your • Offer baby your breast if she seems interested. • It can take a long time to get ready and latching on may • If she doesn’t nurse right away, hold her close until be difficult. A feeding session (breastfeeding, stimulation, she shows interest. burping and diaper-changing) may take between 45 and • The interval between the first two feedings can vary. 90 minutes. • If necessary: • The number and length of feedings is less important than – Let a few drops of milk drip onto her mouth, but don’t the quality of the latch and effectiveness of the sucking. insist if she refuses—be patient; Babies who suck effectively spend less time at the breast – Express milk and give it to her from a spoon or small cup. and are less likely to hurt your nipples. Avoid bottles for the time being. • If your baby falls asleep while you breastfeed, try tickling her, uncovering her, holding her close or talking to her.

Feeding child your Make sure she latches on properly. Try using the breast 438 compression technique. • • Feedings • Your baby each with other comfortable more are child and Mother 8weeks: 2 to in size as they adjust to your baby’s needs. baby’s to your adjust as they in size smaller and touch to the softer become but before milk as as much produce breasts your 8, 6and weeks Between better. one little your to know get you at ease as more feeling and at on latching You’re better getting for longer periods. awake stays and feeding for own Awakens her on

• • • Feedings • • Your baby have own their routine child and Mother From 6months: 2to for feeding—or start doing so again. so doing start for feeding—or at night up wake may still She often. more for the breast may ask she changes: appetite baby’s At 4months, nursing. while her around to look tends baby At 3months, are shorter. Feedings different. something to do wants or if she’s hungry to know easy always not it’s stimulation; more Needs breasts. to change wants when she example, readily—for more needs her Expresses

439 Feeding your child Breastfeeding your baby Breastfeeding an older baby As children near one year of age, they typically breastfeed (6 months and up) only a few times per day, although some may still do so more frequently. At this age, the number of feedings varies Breastfeeding an older baby and a newborn are two from one day to the next, depending on the child’s very different things. Once children start eating other foods activities and mood. at around 6 months of age, the rhythm of breastfeeding gradually changes as your baby adapts to the family’s In Québec, an increasing number of women are continuing mealtime routine. But you and your child can still benefit to breastfeed beyond age 1—even if only once a day— from the advantages of breastfeeding, which will continue because it helps prolong the special mother–child as long as you carry on nursing. relationship they cherish. Breastfeeding for a longer period has ongoing health benefits for the baby. Many As your child gets older, he will start to show curiosity find that breastfeeding in the evening is an enjoyable and initiative, and this can carry over into breastfeeding. part of the bed-time ritual. Support group volunteers His newfound independence may sometimes pose are very comfortable with the idea of breastfeeding problems—he might ask for your breast at inconvenient

Breastfeeding baby your a toddler. Feel free to discuss it with them. times. But trust yourself: in breastfeeding, as in parenting in general, you’ll learn to set limits on what you consider to be acceptable or not. Your baby will learn to be a bit more patient and will get used to breastfeeding on your terms. Feeding child your 440 your child. may also requireactivities you from to separated be outings easier. However, your or professional personal is that itmakes family side of breastfeeding practical One separation mother–child and Breastfeeding nursing in public. comfortable feel who don’t parents areas for care baby and breastfeeding special a T-shirt andsweater) places provide Some ablouse. or things easier, wearing layered (for garments try example, and simplicity. with self-confidence Breastfeed To make that by right law. is protected In Québec, the location. your child, regardlessIt’s your of right to breastfeed in public. are women andmore breastfeeding More public in Breastfeeding you’re visiting traveling. or at outdoors, the movies, Night day,and about! or milk is always handy—whether Breastfeeding makes iteasier to out afamily for get Breastfeeding

Mireille Lewis 441 Feeding your child Breastfeeding your baby You can continue breastfeeding even if you’re not always If you know that you’re going out for a while, you can with your child. You’ll need to consider express milk that your baby can drink from a cup or bottle, depending on his age and abilities. He may only drink The child’s age • a small amount—that happens sometimes. But don’t • His preferences, and yours worry—he’ll probably have a “full-course meal” once you return. • The length and frequency of separation And while you’re out, you may need to express milk Once babies reach 6 months of age, they don’t necessarily in order to relieve breast discomfort. Take along what need to be bottle-fed when you’re away; they can learn you need (for instance, a cooler and ice packs) to keep to satisfy their thirst by drinking from a cup. the milk cool until you return home. Occasional separations Returning to work or school Need to go out for a few hours? If you breastfeed your Returning to work or school will require you to be away

Breastfeeding baby your baby before you leave and once you return, it may not be from your baby on a regular basis for longer periods. necessary for anyone to bottle-feed him while you’re out. Yet many women in this situation continue breastfeeding. A number of them talk about the pleasure they get from snuggling up with their nursing babies before they go out or after they return. Feeding child your 442 will adjust you what“mixed if for is opt called feeding”. milk for you’re him when not around. Your milk production child and to of age-appropriate provide another type You you’re when may with your to also breastfeed decide heavilymore of the time. the rest are away,their mothers make but this up for by nursing while little may They drink very they breastfeed. can until their to moms food from are prefer who separated At 6months age so, or it’s not unusual babies some for and stay healthy—whether you’re by his not. side or excellent nourishment that will help your infant develop with his andabilities. age way This you continue to provide giventhen to in keeping your child in acup bottle or frozen, or refrigerated milk breast be can Once expressed, as you andyour child wish. This special relationship can be continued as long long as continued be can relationship special This

Céline Leheurteux 443 Feeding your child Breastfeeding your baby Is breastfeeding To keep your baby in your room, you need to have your spouse or someone close to you on hand. The hospital still possible? staff can help you start nursing, if necessary. Soon you’ll be able to take care of your baby by yourself. Many dads If you’ve had a Caesarean section also enjoy holding the new baby skin-to-skin on their chest. It’s a good way to get the father–child relationship Whether you planned to have a C-section or not, there’s off to a warm start. nothing to prevent you from breastfeeding soon after your baby is born. Most C-sections are done with an epidural, If your baby is premature in which anaesthesia (freezing) is injected near the base of the spine. So you should be able to breastfeed soon Premature babies have special needs and benefit even after, ideally within an hour of delivery, even if you’re still more from mother’s milk. Breast milk is ideally suited feeling the effects of the epidural. If you have a general for meeting a premature baby’s needs, and you alone anaesthetic (you are put to sleep during the operation), can provide this made-to-order nourishment!

Breastfeeding baby your you’ll be able to breastfeed as soon as you are completely conscious and feeling comfortable. Many hospitals encourage new mothers to nurse for the first time while in the operating room or recovery room. Feeding child your 444 breastfeeding support groups. support breastfeeding certain store or adrug from rent necessary can if one available inpumps intensive are often you or careunits, and keep the supply started ongoing.production Breast his own, to pump to abreast use your you’ll get milk need on waitingWhile until your baby isto able breastfeed they receive.as the food itis considered as newborns for valuable In fact, parents. both babies and their for shown to beneficial be has been to get him to once nurse he’s ready. intimate This contact to you andyourget used smell, which will make iteasier Your with against his yours. skin periods will one little yourIf baby’s long andfor health allows, him often hold into stomach. his directly milk thin to your tube get will the nurses avery use of sucking, at if all.he’s bit, If alittle not yet capable toable breastfeed your baby to only may or able nurse fully time of birth, be on howDepending far along was the at pregnancy the You even your if baby is premature. breastfeed can

Julie Deschamps 445 Feeding your child Breastfeeding your baby The milk that you express can be refrigerated or even You’ll need lots of patience and perseverance during this frozen until your baby is ready for it. When it’s fed to him, phase: premature babies need time to learn to breastfeed. hospital staff may add nutritional supplements, if necessary. Most of them become more skilled at it once they reach their original due dates. Various factors influence how long it takes before a premature baby is ready to start breastfeeding. Your A person trained in breastfeeding can provide invaluable doctor or nurses will tell you when your child is ready. support and encouragement. Préma-Québec, an At first, he may not be able to nurse for very long, so it organization for parents of premature infants, may also will probably be a good idea to express milk afterward be able to help. in order to relieve your breasts and sustain milk production. Little by little, your baby will nurse more effectively and Préma-Québec you’ll be able to do without the breast pump. 1‑888‑651-4909 / 450‑651-4909 premaquebec.ca/en/ Breastfeeding baby your Feeding child your 446 Laura Ottereyes 447 Feeding your child Breastfeeding your baby Breastfeeding baby your Feeding child your 448 so keep expressing milk expressing child.so keep the second for is, the other one to before ready nurse baby is often there’s one twins, With milk of them. enough both for to to able will nurse. This ensure be yourfor twins that You your from milk. more pump milk should while waiting prematurely, are born yourIf twins even benefit they’ll produce. they are your stimulated, more breasts milk the more The milk. exclusively babies your breast on two It’s to possible feed you get! can time. at accept So the same newborns all the help for two itself, the challenge but of caring breastfeeding twins isn’t most of demanding motheringfeedings. The aspect between them for nursing andcaring on with their babies are happy to of twins receive mothers New early help youIf have twins Breastfeeding both twins at practical. once be can twins both Breastfeeding

Alexandra Jacques 449 Feeding your child Breastfeeding your baby Some women prefer to breastfeed each baby separately. There are organizations that can help you, regardless Others find it more practical to nurse both twins at of where you live. Association de parents de jumeaux the same time. Most women use a combination of these et de triplés de la région de Montréal has produced two approaches. a brochure titled Allaiter en double ou en triple (available in French only). Generally, mothers of twins nurse each baby at one breast for one feeding and change to the other breast for the Association de parents de jumeaux et de triplés next feeding. As babies’ appetites and sucking capacities de la région de Montréal will vary, this allows equal stimulation for both breasts. 514‑990-6165 There are other approaches that may be more suitable apjtm.com (in French only) in certain situations.

Some women use mixed feeding, a combination of breastfeeding and bottle-feeding using expressed breast

Breastfeeding baby your milk and commercial infant formula. A person trained in breastfeeding can put you in contact with a mother who has breastfed twins. Feeding child your 450 on breastfeeding. to augmentationBreast have appears less impact formula. commercial infant a with feeding newborn’s to supplement you’ll need nutritional needs, youIf aren’t milk all producing enough your to meet enough milk. of life to make sure weeks that first she’sher receiving to monitor the baby’s during weightnecessary often more more. or It may exclusivelybabies be several for weeks procedures produce enough milk their to breastfeed That said, women some who have undergone reductive to produce milk. to the breast’s capacity decrease appears to (surgery make smaller) the breasts reduction Breast get off to a successfulstart. and having canabout help breastfeeding you support woman to another. Whatever your situation, learning milk on one also supply from varies of such surgery they have of whether surgery. breast had impact The Milk varies production among women, regardless you’veIf had breast surgery producing milk without having gone through a pregnancy. You’ve ababy? adopted It’s even to possible begin youif your never baby. nursed even to able resume be lactation, in breastfeeding—you’ll With trained determination—and from someone support regardless of your baby’sto age. resume breastfeeding possible it’s formulas, infant commercial tolerating trouble are or your child finding that at baby birth, your has didn’t breastfeed breastfeeding, you’veIf stopped production milk Restarting 451 Feeding your child Breastfeeding your baby If you’re breastfeeding—and pregnant Expressing milk If you’re newly pregnant and have been breastfeeding, you can continue to nurse. It’s safe for both your fetus Pumping or manually extracting breast milk lets your baby and your nursing baby. enjoy your milk when you’re not there to feed her, or if she is premature or sick. Expressing milk not only allows If your baby is less than 6 months old, you may not you to maintain your milk supply, but also helps relieve produce enough milk to satisfy her nutritional needs, the effects of engorged breasts. a situation that could affect her growth. In this case, you may have to supplement feeding with a commercial Tips to keep your milk flowing infant formula. Your baby’s nursing stimulates the let-down reflex, The hormonal changes that occur in pregnancy affect which increases milk flow. It’s sometimes harder to the composition of milk (reversion to colostrum) and stimulate this reflex when you’re expressing milk by can also reduce your milk supply. Some older babies hand or with a breast pump, especially on your first Breastfeeding baby your don’t like these changes and lose interest in breastfeeding. attempts. With a little practice, you’ll become good at it. Feeding child your 452 • • • • • • to stimulatethe following methods reflex the let-down on whatDepending you prefer, you can use any of

watching television) watching Distracting yourself with another activity (for instance, with another activity yourself Distracting your baby about Thinking of yourVisualization baby nursing Warm compresses massage Breast Self relaxation expressing milk. expressing gentlyhandle your andto breasts wash your hands before to you choose, it’s important of the method Regardless • • • • Your choice on will depend of method in of ways. anumber expressed milkBreast be can milk expressing for Choosing method a

or not And of course, your own preference yourHow you baby—that are feeding is, breastfeeding youHow frequently situationThe express milk 453 Feeding your child Breastfeeding your baby How to do a breast massage How to express milk by hand

To relax your breasts before expressing milk, try a technique Manual expression is a technique every mother should know. It’s the most effective way to express colostrum, you can borrowed from massage. The idea is to use the knuckles to use it any time, anywhere to relieve an engorged breast, and it’s free. gently stimulate the breast. This technique is easier than it sounds. Ask hospital staff, your midwife, or a CLSC nurse to teach it to you. • Make a fist and keep it closed throughout the massage. • Wash your hands. • While maintaining pressure on your fingers, pinch your thumb and index finger together as if they were • Place the knuckle of your index finger at the top • Use a large, clean container. of your chest and roll your knuckles down toward 1 a pair of pliers. You don’t need to press hard. This motion the nipple. • To prompt the let-down reflex, massage your shouldn’t leave any mark on your breast or cause breast gently. any pain. • To massage the underside of the breast, place the knuckle of your little finger against your ribs and roll your knuckles • Lean forward slightly so the milk can flow into • Repeat this pinching motion several times, up toward the nipple. the container. reproducing the same rhythmic movements your baby uses when nursing. • Move your fist to the other breast and repeat • Make a “C” with your thumb and index finger. The tip of Breastfeeding baby your the rolling motion. each should line up like a pair of pliers (see photo no. 1). • Be careful not to slide your fingers along your breast. Maintain firm pressure on your breast without stretching Place your thumb and index finger on either side of • Work your way around the breast once or twice, then start 2 • the nipple, which is painful and not very effective. expressing milk. the nipple, 2 to 5 cm (1 to 2 inches) away. With practice, you’ll find the best distance (seephoto no. 2). • Work your way around the breast with your fingers until it’s emptied. Massage shouldn’t be painful. You can repeat this massage • Press your fingers into your breast, pushing horizontally once or twice while you’re expressing milk. toward the ribs (see photo no. 3).

Your milk will flow drop by drop at first, then begin to spurt. With practice, you’ll be able to work more efficiently and quickly. Feeding child your 454 3 Jean-Claude Mercier and quickly. Yourpractice,efficientlyable With bemore you’ll to work milkbegin will flow tospurt. dropthen by drop at first, • • • • • • • techniqueThis is staff, hospital easier Ask than or a itsounds. your to midwife, nurse CLSC teach it to you. use it any to andit’s free. relieve time, breast, anywhere an engorged way know. should mother Manual is expression atechniqueto every effective It’s the most How toexpress milkby hand toward the ribs (see you’ll find thedistance best (see the nipple, 2to 5cm (1 to 2 inches) away. practice, With each line should up like (see apair of pliers the container. breast gently. Press your fingers into yourbreast, pushing horizontally Place your either of on side thumb finger andindex Make a“C” with your thumb finger. andindex The tip of slightly the milk so Lean flow can forward into To massage your reflex, prompt the let-down container.Use clean large, a Wash your hands. photo no. 3 ). photo no. 2 photo no. 1 ). ). • • • • until it’s emptied. the nipple, which is andnot very effective. painful stretching without breast on your pressure firm Maintain baby uses when nursing. movements your rhythmic reproducing the same times, several motion pinching this Repeat any pain. shouldn’t leave any your mark on cause or breast Youa pair of pliers. to press hard. motion This don’t need your thumb andif as they finger were together index Work your way around the breast with your fingers not to slide breast. careful along your your Be fingers pinch fingers, your on pressure maintaining While express colostrum, you can you can colostrum, 455 Feeding your child Breastfeeding your baby Choosing a breast pump You should also consider the following factors: It is not always necessary to buy a breast pump. Many Quality – A poor quality breast pump may hurt you women prefer to use one, however, especially if they or reduce your milk production. have to express their milk on a regular basis. To find a breast pump that suits your needs, contact a community The number of sucking movements per minute – breastfeeding support group or a person trained Choose a breast pump that allows for 60 to 70 sucking in breastfeeding. movements or cycles per minute so that it imitates as closely as possible the rhythm and strength of your A number of models are available on the market: baby’s sucking. Manual breast pumps • Suction – A breast pump with insufficient suction reduces • Various types of electric breast pumps, including the quantity of the milk expressed, whereas suction that some that allow you to express milk from both breasts is too strong and prolonged irritates the nipples. at the same time. Breastfeeding baby your Size and shape of the cup – The breast pump’s cup, which fits on the nipple andareola , must be properly adjusted to your nipples to avoid injuring them. Some companies offer a number of models and sizes. Feeding child your 456 • of a pump manual breast good Caracteristic • pump breast electric agood of Caracteristic • • • of anyCharacteristics pump breast good

per minute strong or prolonged Be comfortable and not tire your hand not and comfortable Be Create at 60 to 70 suction andrelease cycles your byProtect nipples avoiding that is too suction Fit your nipples properly and leakproof Be maintain suction proper nipples and breast pumps nipples and breast use first the before disinfected to clean itproperly. is important to be It also needs pump you of breast choose, it of the type Regardless , page 507) (see Cleaning bottles, bottles, Cleaning . 457 Feeding your child Breastfeeding your baby Second-hand breast pumps If you buy a second-hand breast pump that is not hospital grade, keep in mind that there may be milk remaining in Most breast pumps, whether manual or electric, are the motor. Since there is no way to check this or to clean intended to be used by only one mother. They must the motor, there is a risk of contamination, even though therefore be considered as a personal item, just like the risk is low. For this reason, it is recommended that a toothbrush or underwear. Breast milk can transmit you not buy a second-hand breast pump. If you decide diseases like HIV and hepatitis, or less serious infections to do so, be sure to buy a new set of tubes. like thrush. Boiling a second-hand breast pump does not make it safe, even if it does reduce the risk of disease transmission. Expressing milk occasionally or regularly If you breastfeed, your milk production has adjusted Hospital-grade electric breast pumps are, however, to your baby’s demand. So it is normal to express only designed to be used by multiple mothers. You can rent a few drops on your first few attempts. Be patient. hospital-grade electric breast pumps from community breastfeeding support groups and some drugstores.

Breastfeeding baby your There is no ideal time to express your milk. The These breast pumps are sturdy and high quality. They are ideal moment is the one that suits you the best! intended to be used by many people, so they are designed Try these suggestions: in such a way that the pump motor never comes into contact with the milk. In fact, it is the motor you rent: each • When your baby has fed at only one breast woman must buy a new set of tubes, which includes all In the morning parts that come in contact with the milk. • • When your breasts are engorged • Between feedings • While your baby is feeding at your other breast Feeding child your 458 • When you skip a feeding you feed your baby milk. breast you feed months, throughout or the entire period days, weeks, youron situation, your you express milk can several for simply Others prefer this Depending method. breastfeed. milk won’t ababy express women for who Some breastfeeding without milk Expressing time. some for from the milk that abreast express from your baby has not fed asmall only Youget amount of milk. you if more will get youIf your breasts, the more milk the more theyyour will breasts, produce. you more stimulate The times your you express milk. express It is normal to get only a few drops the first few afewIt isto drops only normal the first get milk between feedings, you will probably you will probably feedings, milk between to your baby’s individual needs. to your baby’s individual andadapts going will gets change as your milk production wayThe your you express milk not breastfeeding when milk as your if baby were term. full express to your better it’s start, off good to a production suckdo not as effectively.However, to get your milk at if all andthey they drink only alittle evenor weeks, few days,intestines In the first are not yet developed. fully their and smaller are babies that premature Remember again. breastfeeding you want to try is hesitate high. Don’t to ask if help production for succeed your if in so doing milk at birth breastfeed month, many the first not who did During babies 459 Feeding your child Breastfeeding your baby Feeding your baby with your milk without breastfeeding

Before your milk comes in When your milk comes in

Frequency Frequency • If possible, start stimulating your breasts within 6 hours • Express your milk as often as necessary for comfort’s sake, after the birth. but at least 8 times a day. • Express your milk 6 to 8 times a day. • Use the breast pump at least once every 4 hours, even • Use the breast pump at least once every 6 hours, even at night. at night.

Duration Duration

• After expressing the colostrum by hand, use the breast • Express your milk until your breasts are soft pump for 5 to 10 minutes.

Breastfeeding baby your and comfortable.

Quantity Quantity • You will produce from a few drops to several milliliters. • The quantity of milk increases rapidly. Take advantage of The colostrum (first milk) is thicker. this period to get your milk production off to a good start, • Expressing milk by hand seems to produce more milk than even if your baby drinks much less that you express. the breast pump during the first 24 to 48 hours. As your Stock up. milk changes, it will become easier to express with the • Mothers who express at least 500 ml of milk per 24 hours breast pump. after the first week seem to produce more milk afterwards. • The quantity of milk usually increases from 48 to 72 hours after the birth. Feeding child your 460 • • • Quantity • Duration • • Frequency 6weeks 1 to two weeks seem to produce more milk afterwards. milk more to produce seem two weeks each time. rapidly. will increase which needs, her of ahead stay always will you That way 2minutes. for about at night. Express Mothers who express at least 750 ml per 24 hours after 750 after 24 at least per ml hours express who Mothers varies express you milk of quantity the that normal It’s drinks. baby your than milk more alittle Try to express flowing stopped has milk until the milk your Express even 6hours, every once at least pump breast Use the your milk 6 to 8 times aday. 6to milk 8times your • • Quantity • Duration • • Frequency 6weeks After drinks in order to stay ahead. to stay order in drinks baby’s needs. needs. baby your and others not. needs. baby’s to your Ideally, try to express a little more milk than your baby baby your than milk more alittle to express Ideally, try to your according express you milk of quantity the Adjust milk of have until you milk your have quantity the Express at night, milk expressing stop can women Some adapt can you produce, you milk much how on Depending 461 Feeding your child Breastfeeding your baby Combining breast and bottle Some babies will switch back and forth between breast and bottle without any trouble, while others find the transition more difficult. After being fed from the bottle To suck from a bottle or from your breasts is not the same. several times, some babies don’t open their mouths Here are the main differences: as wide to take the breast or get frustrated when the • Your baby has to open her mouth wide to latch on to milk doesn’t flow as fast. the breast, which is not the case with a bottle. Here are some tips to make the breast/bottle Milk sucked from your breasts flows faster at first • combination easier: and when you have a let-down reflex, while milk from a bottle flows at a constant rate. • Don’t introduce the bottle until breastfeeding and milk production have settled into a pattern (around Most bottles will drip into your baby’s mouth even • 4 to 6 weeks). when she doesn’t suck, which is not the case when she drinks from the breast. • Wait until your baby opens her mouth wide before

Breastfeeding baby your giving her the bottle. • Opt for a slow-flow bottle nipple. • Give your baby breast milk in a bottle rather than commercial infant formula. It will help you maintain a good milk supply. Feeding child your 462 every day. every formula commercial infant milk and breast drinks both your is baby when (orPartial mixed) breastfeeding don’t. while others of breastfeeding adapt well to thisSome babies type you and your longer. baby to enjoy breastfeeding can continue nursing. approachmay This allow is way the only you breastfeeding partial where baby,to feed your you may in a situation find yourself way is the best Although exclusive breastfeeding mixed breastfeeding or Partial • • • • • awareyou be should of the following: whatever your reason for choosing breastfeeding, partial of However,time. periods of reasons, different andfor anumber for Women breastfeeding may partial choose

the breast, eventhe breast, your if milk is supply plentiful. milkwhen drops. production stimulated. less are day, your breasts will drop because your milk production willproduction last. Complete interest andlose in may babies the bottle prefer Some gradually interest lose babies inSome breastfeeding your baby commercial you If feed infant formula every your your milk more the longer baby nurses, The weaning may occur earlier than anticipated. than may earlier occur 463 Feeding your child Breastfeeding your baby If your baby refuses the bottle Here are a few tips to help ease the introduction of the bottle: Some babies, regardless of their age, simply don’t like drinking from a bottle. This is perfectly normal; after all, • Wait until your baby is in a good mood and not too bottle and breast are quite different. Occasionally, babies hungry before making the change. who have had no problem drinking from both breast Introduce the bottle for a milk “snack.” Your baby and bottle may suddenly start refusing the bottle after • will probably drink very little to start with. a few months. As they grow, babies learn to express their preferences better, and some make their choice • Get the father to give the bottle. Discreetly leave perfectly clear! the room at feeding time. Try with breast milk first, then with commercial This can be a difficult situation for parents, especially • infant formula. if the mother feels trapped or obliged to breastfeed. Be patient, and don’t force your baby one way or the other. • Try giving the bottle differently from the way you He is not likely to accept something new if he’s frustrated. present the baby your breast. Change routines. Breastfeeding baby your • Patience! If it doesn’t work the first time, try again a few days later.

If you have tried these tips and your baby still refuses to take the bottle, you can try giving him some milk in a little cup. He may be more willing to take it. Feeding child your 464 Julie Desrosiers 465 Feeding your child Breastfeeding your baby Weaning Weaning babies under 9 months old Milk production declines gradually as breast stimulation Weaning age varies from one child to another. Whether is reduced. Gradual weaning helps you to avoid engorged it’s the mother or child who initiates the process, various breasts and reduces the possibility of mastitis. The time factors affect weaning: the child’s age and temperament, it takes to stop producing milk altogether varies from one the mother’s feelings and the approach used. woman to another, however it generally takes about four weeks to wean your baby completely. This gives your child Give yourself time. Be attentive to your child’s reaction time to adapt. Weaning faster may be hard on both you and stay flexible. If possible, it’s better to delay weaning and your baby. a sick child. She needs her mother’s milk and the comfort she gets from breastfeeding. Start by replacing one daily breastfeeding with an iron‑enriched commercial infant formula served in a baby bottle or cup. Between feedings you can empty your breasts by expressing some milk or letting it flow under a Breastfeeding baby your hot shower. Feeding child your 466 the calcium and protein he needs tothe calcium andprotein grow. needs he full hisyear for of first life,providing food his primary and make sure he’s milk—it enough will remain getting him cupthe often, Offer needed. if with ababy bottle Finish normal. up a small is This amount perfectly of milk. aregular cup. only drink from willhe probably At first, drinking At of 6months the age about your baby start can afew minutes. for youralso let baby breastfeed to hesitate Don’t breastfeeding. the “last” afew daysfor after with milk engorged their breasts will feel mothers Some feedings. morning and bedtime main continue the as you want.as many Many mothers breastfeedings in arow. breastfeedings Youtwo gradually can replace you’re when feeding a second ready. don’t At skip first, Once your engorged, breasts replace no longer feel express some milk to ease the discomfort. You milk some to ease the discomfort. can instead of breast milk. breast of instead milk to drink 3.25% homogenized your baby start can 9months, is she eating provided about By abalanced diet, wantingwithout to nurse. days going and less as your at baby atime eventually starts massage, back-rubs You on. andso less will breastfeed to idea introducea good other such moments—rocking, you’re If to wean contact. your child,comforting it’s trying of amoment is often breastfeeding babies, For older to suck. they the need lose Many childrencontact. interest lose in when the breast nutrition for and needs her other ways of satisfying you wish to wean her. to encourage Gradually her develop yourAs child older, gets you can decide how quickly months 9 Weaning than older babies 467 Feeding your child Breastfeeding your baby Here are a few suggestions to ease the transition: Breastfeeding problems • Don’t refuse your baby the breast if she wants it, and solutions but gradually stop offering it. • Delay feedings if she’s not too impatient so they Some new moms find breastfeeding easy right from are spaced further apart and reduced in number. the start. Others find it more challenging, especially in the first few weeks. If you fall into the second category, Offer her a nutritious snack. • you will find all kinds of information and solutions • Distract her with a game or other stimulating activity. in the next few pages. • Reduce the length of feedings. • Change your daily habits, e.g., don’t sit in the chair If you are experiencing one of the following you usually use to breastfeed her. problems, it is advisable to seek professional advice: • Difficulty getting the baby to latch on

Breastfeeding baby your Consult a community breastfeeding support group, if needed. • Pain or lesions on the nipples or breasts • Baby not gaining enough weight • Problems with milk production Feeding child your 468 • • • • youIf are problems, experiencing consider these options: decision. important time to make not agood suchThis is probably an Feeling tired, discouraged, confused? ambivalent or originally determined to very breastfeed. about think will many doesn’tas go planned, new mothers breastfeeding When problems. toa solution their breastfeeding they can’t discouraged when find get women Some your baby? weaning of thinking and Discouraged

commercial infant formula. commercial infant yourhelp baby latch on temporarily or permanently reduce or stop nursing. Express Opt for partial (or mixed) breastfeeding by introducing (or partial for mixed) breastfeeding Opt Try reduce pain and sometimes It can shield. anipple Consult trained in someone breastfeeding. milk from one or both breasts so you can you so can breasts both or milk one from weaning their baby, even they if were (see Nipple shields Nipple , page 474) . Don’t be afraid to seek help. to afraid seek be Don’t assistance extra some just or encouragement. need and are considering weaning your baby, maybe you If you don’t think you can continue breastfeeding youIf don’t think you continue can breastfeeding

Jean-Claude Mercier 469 Feeding your child Breastfeeding your baby When breastfeeding doesn’t go as planned Giving birth to and caring for your baby is one of the most intense experiences you will ever have.

In the first few weeks, you may often find yourself crying from fatigue and hormonal changes. Breastfeeding, too, is an emotional time.

Breastfeeding is not always easy and for some women, it can be downright difficult. Even with excellent support and specialized assistance, there is a possibility that your breastfeeding experience simply doesn’t live up to your expectations. Some women feel regret, sadness, frustration and even anger because they are unable Breastfeeding baby your to achieve the goal they had set for themselves. Others feel guilty for wanting to stop breastfeeding. Remember, it’s not your fault! Successful breastfeeding depends on a number of factors that you can’t always control.

Jean-Claude Mercier It’s good to be able to talk about your feelings with someone you trust and who will lend an ear. Every birth Having the support and reassuring presence and breastfeeding story is unique. of the baby’s father or someone close to you can often make all the difference. Feeding child your 470 is not showing above. the signs described You should stimulate your alot and sleeps baby he if they will have all the milk ahard they need. time getting Thismeans or 3 2 weeks. duringespecially the first much so they feedings, may sleep some babies skip Some each haveBabies that their own rhythm changes over time. • • • • • what to do. Follow he if him sleep andlet his rhythm you wake should him to nurse. It’s not always to easy know yourIf baby sleeps a lot, you probably wonder whether Your baby lot a sleeps

to gain weight 24 hour period Has regained his birth weight andcontinues his birth Has regained nursing after satisfied Is calm andseems Pees at 6times aday andpasses least at 3stools least andswallows nursing well when andsucks Is active Wakes his on own to in 8times more a or nurse drinking enough milk during feedings him drinkon helping in more the section yourIf baby while falls nursing, the tips asleep check easier to wake. stimulate him or changetry to his diaper, as will he be that he is in time to alight phase. Now is sleep agood moving his eyes his beneath eyelids? are signs These movingIs motions he in his sleep, sucking or making him. observing youIf have to by wake your baby to nurse him, start What todo light and sleep. deep alternate generally Babies sleep. is in a between deep It’s easier to wake is ababy who dozing than who one , page 477, page Your baby is not . 471 Feeding your child Breastfeeding your baby Your baby has trouble latching on In other cases, it may be that the mother Newborns don’t all develop at the same pace. Some take • Has flat orinverted nipples longer to learn how to latch on properly. If your baby Has nipples that are usually erect, but that retract when has trouble latching on in the beginning, you can continue • the baby tries to latch on to breastfeed by expressing your milk. Don’t worry, your baby is not rejecting you! If she gets frustrated and pushes • Has very hard or engorged breasts on your breast, it’s because she’s hungry and can’t quite manage to latch on. Most of the time, babies have difficulty latching on due to a combination of factors. However, there may be cases Babies may have trouble latching on if they when there is no obvious reason. • Were born prematurely and are less efficient at sucking • Have a sore head following the delivery

Breastfeeding baby your • Have difficulty sucking • Have a tight lingual frenum (membrane under the tongue is short and impedes tongue movement) • Prefer the bottle (if they have already been bottle-fed) • Refuse to take the breast after having been forced to nurse Feeding child your 472 • • • • tips: few a are Here What todo

for afew minutesfor to down. calm her positions. nursing cup to calmof your milk her. little or in aspoon abit by her giving too hungry,If she seems start (see If your baby gets frustrated, remove your frustrated, from breast your her If baby gets Try specific prefer babies positions. differentSome too hungry. gets she your baby before Breastfeed to relieve them try are your engorged, If breasts Engorgement , page 492) . guide her. patient, this Be take can afew minutes. gently then the breast, out seeking wait until starts she and Relax your breasts. between lay her skin-to-skin Strip down to diaper, her her remove your and bra Let yourLet baby discover innate her reflex. sucking

Cécile Fortin 473 Feeding your child Breastfeeding your baby If your baby doesn’t latch on, there’s no point insisting. Your baby refuses one breast but takes You can always complete the feeding with expressed the other breast milk: Some newborns will have no trouble taking one breast, • Keep feeding your baby. Don’t skip a feeding because but refuse the other. Don’t worry, this is quite common. your newborn can’t latch on properly. If this happens, express some milk from the breast the baby refuses, to stimulate production. Keep offering Express milk to keep your milk production up. Babies • him the breast in question but don’t force him. He will seem to find it easier to learn to latch on when milk eventually take it. production is plentiful.

This period requires lots of patience, confidence and Nipple shields support. Try to avoid introducing the bottle or using Nipple shields are a breastfeeding accessory made a nipple shield during this time. of moulded silicone that adjusts to the shape of the breast. They come in various sizes and models.

Breastfeeding baby your Many babies will eventually learn to latch on, especially if they are less than 6 weeks old and milk production They are sometimes recommended when the baby is good. does not take the breast or when the mother’s nipples are painful. Feeding child your 474 • • • the following reasons: for best avoided always almost There is an alternate are They solution. few days not in the first breastfeeding. of preferably and as only resort alast used shields be must Nipple

and can cause adrop inand can cause milk production. to shield. take anipple refuse without the breast on properly. Their use results in reduced breast stimulation stimulation breast reduced in results use Their to subsequently itandcan used gets baby quickly The the baby shield, to doesn’t anipple learn With latch the breastfeeding period. the breastfeeding shields throughout may nipple used cases, be In some in breastfeeding. trained aperson contact it, without you If are finding solved. it hard has been breastfeed to You should stop using as the problem as yours soon Nipple shields are use. generally for temporary • • • • • you for to the solution be seems shield anipple If

a day to keep up your milk production Express is causing problems Stop using as you itas can soon only of the feeding Use part itfor breast side,Use one one only on if itonly that one Choose is in size closest to your nipple your milk after each feeding several times each feeding your milk after 475 Feeding your child Breastfeeding your baby Your baby was breastfeeding but now What to do refuses to Healthy babies who are at least a few weeks old can easily Sometimes a baby who was perfectly happy to take the go for several hours without feeding. breast will start to refuse it. In some cases this will happen all of a sudden, while in others, the baby gets increasingly Here are a few tips: impatient while nursing until she eventually refuses the breast altogether. • Try for short periods (10 minutes) when she’s calm and not too hungry. What if you know your baby is hungry, but she can’t Don’t force your baby to take the breast. seem to latch on or simply refuses to take the breast? • While there may be no obvious reason, there are • Calm your baby before nursing by offering her a small a number of possible causes: amount of breast milk in a spoon or small cup. • Your breasts are engorged, making it difficult • Offer your baby the breast just as she’s about to wake up.

Breastfeeding baby your for your baby to latch on. • Hold your baby in your arms and offer her the breast • Your milk flow is slowed by a blocked duct ormastitis . while you’re moving or walking. • Your baby has a growing preference for the bottle. • Try taking a bath with your baby and nursing her in the water once she’s fully relaxed. • Your baby is not feeling well or has a stuffy nose. If the situation doesn’t resolve itself after a few feedings, This situation usually sorts itself out in a few days. contact someone trained in breastfeeding. Feeding child your 476 your milk production is likelyyour milk to decrease. production stimulation lack too long, your for proper If breasts • • • • are who with babies the case often isThis most evenmilk your your if from breasts, milk is supply plentiful. effectively.cases In like these, mayshe enough notget situationsSome causeyour can baby to less nurse during feedings Your milk enough baby drinking not is

Losing weight failing or to gain weight Sufferingfrom jaundice from theExhausted delivery 35 and37 term (between before Born weeks) when breastfeeding. when conditions if your baby isn’t drinking enough milk A small cup may be used under certain A small certain cup under may used be

Sophie Cliche 477 Feeding your child Breastfeeding your baby What to do If these tips don’t work, or if your milk production drops off, you may have to use a commercial infant formula • Check that your baby is latching on properly to fulfill your baby’s milk requirements(see Insufficient and improve his latch, if possible. milk production, page 480). Contact someone trained in breastfeeding if the situation doesn’t resolve itself Breastfeed more frequently, at least 8 times every • quickly or if you are concerned. 24 hours. Wake your baby to nurse if need be. • Offer the breast rather than a pacifier to comfort your baby. Pacifiers don’t provide milk and can mask signs of hunger. • Compress your breasts at each feeding (see Breast compression, page 435). • Stimulate your baby so that he nurses effectively

Breastfeeding baby your and swallows regularly throughout the feeding (talk to him; massage his back, legs, arms, etc.). • Switch breasts once your baby stops swallowing during the feeding. • Express milk between feedings and offer it to your baby, preferably from a spoon or little cup. Avoid using a bottle. Feeding child your 478 be softer after a few weeks of breastfeeding. afew weeks after be softer for infants enough, producing enough milk or that your milk isn’t nourishing say.other people concluding Before that you aren’t page 314) nothing to with alack do of milk have of reasons all for kinds that often cry Newborns on demand. nurse her so long as your baby is latching andyou correctly on is This highly unlikely periods. long nurse often or for their baby to cries andwants enough milk because they aren’t producing Many newworry moms Worried you don’t have milk? enough take the time to consider the situation. It’s normal . Try influenced be whatby not to yourself let to breastfeed often and for your breasts to your andfor breasts often to breastfeed (see Temperament , • • • • What todo

during each feeding. page 435) if she sucks more effectively. to suck actively. She may milk more get faster Youmore thanonceboth breasts also can offer compressionBreast help can Stimulate your baby to ensure continues she Make sure your baby is latching properly. on . (see Breast compression Breast , 479 Feeding your child Breastfeeding your baby Insufficient milk production • You have an insufficient number of mammary glands, regardless of the size of your breasts Sometimes, milk production is low right from the start (glandular insufficiency). of breastfeeding. In other cases, it can drop off suddenly. This may be temporary, and can be due to any of a number • You are pregnant again. of different causes: • You are taking contraceptives or a decongestant • Your breasts are understimulated because: containing pseudoephedrine. – they are not being stimulated often enough Sometimes insufficient milk supply cannot be explained (less than 8 times a day); by any of these reasons. Regardless of the quantity – they are not being stimulated correctly by your produced, the quality of breast milk is always excellent. baby or your pump; Even in small amounts, your breast milk provides your baby with a host of nutrients that are not found in – you give your baby commercial infant formula commercial infant formula. in a bottle every day. Breastfeeding baby your If your milk production is insufficient, make sure your baby You have undergone breast surgery (breast reduction). • is drinking enough and continuing to gain weight. Even • You suffer from poorly controlled hypothyroidism if you supplement feedings with commercial infant formula, or another health problem. you can still continue to breastfeed. Feeding child your 480 • • you help can This person. You support also can to talk breastfeeding atrained not drinking enough milk during feedings To your help effectively, more baby nurse see and often your breasts is to way your stimulate milk to best production boost The What todo

Increase your production as much as possible as much as production your Increase Assess your milk production express as much milk as possible. possible. as milk much as , page 477, page Your is baby . boost milk production. milk boost Talk to your doctor, that adrug recommend can helps who is still low, yourIf milk production discouraged. don’t get them. clean andshow the tubes supply can CLSC you how to use and Yourcontinue to at your breastfeed. anurse or midwife you aids help can while you the breast on nurse. These aid that is placed alactation catheter or called tube a little alsoShe can discuss of using with you the possibility 481 Feeding your child Breastfeeding your baby Milk flow What to do Your breasts may leak milk between feedings or at night. Here are a few suggestions to make nursing more This is a normal, natural way for your breast to relieve enjoyable. Try the first suggestion, then add the others themselves. If it bothers you, you can protect your bed one at a time to see what works best for you. linens with a towel and wear nursing pads during the day. • Remove your baby from your breast for a few minutes Very fast milk flow if the milk starts flowing too fast. (strong let-down reflex) • Try different breastfeeding positions to see if there is one After nursing for a few minutes your baby will start that suits you and your baby better. swallowing loudly. He may even choke a little or stop If you have a lot of milk, try offering only one breast nursing and start crying when milk runs onto his face. • per feeding; this may be enough to satisfy your baby. Your baby is upset because the milk is flowing too quickly. Express just enough milk from the other breast so This happens most often around the age of 1 month.

Breastfeeding baby your you’re comfortable. As babies grow older, they adapt better. • If your breasts are very full before nursing, express about 15 ml (1 tablespoon) of milk to trigger the first let-down reflex and slow the initial milk flow. Feeding child your 482 nipple pain, along with advice andrecommended treatment. pain, along nipple common of causes the most of list some following charts toreasons wean decide women early. their babies The Persistently andcracked painful of are the main nipples one lessen. the pain will quickly is corrected, as the causeof the discomfort As soon latch. common causeof most pain is an incorrect The of the pain. of nursing because of nursing to fearful or be seconds 30 the first pain after It is to not normal feel painful. be not should breastfeeding this time, After your baby are still in the learning period. You at ofespecially afeeding. the beginning and may your sensitive,nipples be week, the first During Painful nipples • • • • • causes: have can various nipples cracked and Painful nipples cracked or painful of Causes

Thrush blister Milk Vasospasm Eczema or dermatitis latch Poor 483 Feeding your child Breastfeeding your baby Poor latch

What is it? What to do?

• Most common cause of nipple pain and chapping. • Improve the latch so it looks like the photo on page 429. • Pressure on the nipple between the baby’s tongue • Begin nursing with the less sensitive breast. and palate when he hasn’t taken enough of the • Vary breastfeeding positions. areola into his mouth. • Put a few drops of breast milk onto the nipple at the end of a feeding. Possible signs • Use an analgesic such as acetaminophen (e.g., Atasol® or Tylenol®). You should feel a difference as soon as the baby improves the latch. You’ll feel You’ll see N.B.: Over-the-counter ointments and creams provide some relief but won’t solve the problem. • More pain at the start • A deformed, flat of feeding. or pinched nipple Not feeling any better? when the baby Breastfeeding baby your releases the breast. • If nursing your baby is too painful, it’s important to express your milk • Chapping or cracks to prevent engorged breasts and maintain your milk production. that may bleed. • If you’re in too much pain, promptly ask for help. • If your cracked nipples don’t heal or improve after correcting the latch, see a doctor: you may need antibiotic ointment. Feeding child your 484 Eczema or dermatitis or Eczema • You’ll feel Possible signs • • it? is What between feedings. between and during sensation A burning or hitching hitching or A burning material. or to aproduct reaction Allergic moisture. excessive or to frequent reaction Skin • • You’ll see Dry, cracked cracked Dry, or peeling skin. or peeling the on visible most to be tend which red patches, Pinkish or bright bright or Pinkish areola . • anyNot feeling better? • • do? to What before feeding. product to the remove need is no There 3to 5 days. for feeding Apply a thin layer of over-the-counter 0.5% hydrocortisone after every every after hydrocortisone 0.5% layer athin over-the-counter of Apply products. other or lanolin lotions, any creams, Stop applying See a doctor for diagnosis and to get appropriate treatment. appropriate to get and diagnosis for adoctor See 485 Feeding your child Breastfeeding your baby Vasospasm

What is it? What to do?

• Spasm or contraction of the blood vessels brought Vasospasms are harmless, so no treatment is needed if you aren’t in on by the nipple coming into contact with cold air any pain. when the baby releases the breast. To prevent or reduce pain, try these tips: • May come and go one or more times • Check and correct the latch as needed. between feedings. • Apply dry heat, such as the palm of your hand or a magic bag to the • Caused by a poor latch. nipple immediately after nursing. • Worsened by nicotine and caffeine. • Keep your body warm. Possible signs You’ll feel You’ll see Breastfeeding baby your • A burning sensation • Part or all the nipple Not feeling any better? in the nipple or turns white. Vitamin B may provide relief. The dose is 150 mg per day for 4 days, throughout the breast. • Nipple returns • 6 • Pain on contact to its normal colour followed by 25 mg per day until the pain disappears. Discontinue use with a cold wind a few seconds if there is no improvement after a few days. or when you come to a few minutes • Prescription medication can also be effective. See a doctor if needed. out of the shower. after nursing. • Pain completely disappears a few seconds to a few

Feeding child your minutes after nursing. 486 Milk blister Milk • • You’ll feel Possible signs nipple. the of end of the out coming milk blocks that layerA thin skin of it? is What pain Intense the breast. or hard area in feeding. of start at the especially breast, the throughout and sometimes in the nipple Possibly a lump alump Possibly • You’ll see protrude slightly. that may nipple the of tip the on pimple Small (1–2Small mm) white • anyNot feeling better? • • • do? to What it and make the start of feeding less painful. less feeding of start the it and make the blister. Apply an ice cube to the end of the nipple for 1 to 2 minutes to numb to 1to numb 2minutes for nipple the of end to the ice an cube Apply to open able may be she bath: your after right baby your Nurse nipple. the on skin the Take to soften bath hot along, If this doesn’t work, contact a person trained in breastfeeding. in trained aperson contact work, doesn’t this If 487 Feeding your child Breastfeeding your baby Nipple thrush

What is it? What to do?

Fungal infection that can An ointment is often all you need to treat an infection that is limited • Appear in a baby’s mouth (see Thrush in the to the nipple and areola: mouth, page 626) • Choose over-the-counter nystatin (e.g., Nilstat®, Nyaderme®, • Cause diaper rash Mycostatin®) or miconazole (e.g., Micatin®, Monistat Derm®) ointments • Occur in the mother, even when the baby • Apply a thin layer after each feeding. You don’t need to remove has no visible thrush in his mouth it before nursing • Continue treatment for a few days after the pain goes away Possible signs You’ll feel You’ll see

Breastfeeding baby your Pain in the nipple or • No changes to Not feeling any better? inside the breast, which the nipple or areola. • Burns, more intensely • Cracked or • If there’s no improvement after 5 days or you experience breast pain, at the end of feeding redder nipple. see a doctor for diagnosis and to get appropriate treatment. • Strikes out of the blue • Red, smooth • Comes gradually and shiny areola. or in addition to existing pain Feeding child your 488 489 Feeding your child Breastfeeding your baby Breast pain Causes of breast pain Breast pain is less common than nipple pain. Often the pain is accompanied by a lump or hard area on the breast. There are several possible causes for the pain: Breast pain is not normal. Treat the problem promptly or Thrush in the breast see a health professional if necessary. • • Engorgement • Blocked milk duct • Mastitis Breastfeeding baby your Feeding child your 490 Thrush breast in the • • • • You’ll feel Possible signs breast. the in occur can that Fungal infection it? is What during Pain Pins-and-needles inside Burning much more frequent. much more but vasospasm, at night. maythat you wake feedings or between the breast. through sensation the breast. Pain to similar • • • You’ll see Thrush sometimes sometimes Thrush sometimes Thrush with breast Normal baby’s mouth. in the visible nipple. the on visible lumps. or redness no be prescribed. may also orally administered Adrug treatment. another may prescribe doctor The work. not does treatment prescribed the if adoctor See anyNot feeling better? • do? to What appropriate treatment. Consult a doctor for a diagnosis and to receive the the to receive and adiagnosis for Consult adoctor any concerns this about issue, to talk ahealth professional. of cancer, you If have recommended. is use longer no andits may that to exposure increase thisknown the risk product treatment thrush. andbreast nipple However, for itis now In the past, gentian violet was recommended as a was recommended gentianIn the past, violet 491 Feeding your child Breastfeeding your baby Engorgement

What is it? What to do?

• Surplus of milk in the breast. • Nurse more frequently, particularly when your milk is coming in. • Milk production exceeds baby’s demand. • Apply ice for 10 to 15 minutes every 1 to 2 hours between feedings • May occur when your milk comes in, during to help reduce swelling and pain. periods when baby drinks less than usual • Express enough milk to soften the areola if your baby has or during abrupt weaning. trouble nursing. Express milk after nursing if your baby hasn’t drunk much. Express Possible signs • enough to be comfortable without trying to empty your breasts. You’ll feel You’ll see • As needed, acetaminophen (e.g., Atasol®, Tylenol®) or ibuprofen (e.g., Advil®, Motrin®) reduces pain and is not dangerous for the baby. • Heavy, tight breasts. • Breasts that are Not feeling any better? Breastfeeding baby your • Breasts that may hard to the touch. be slightly or very • Tight skin on breasts. If your breast is very red or you start to run a fever, you might painful, according • Skin that may have mastitis. to severity be red and warm. of engorgement. You do not have a fever. Feeding child your 492 Blocked milk duct or aches. You have no fever • You’ll feel Possible signs • • it? is What of one breast. carrier. or infant by abra pinched was breast the or because Pain in an area Pain area an in long too for full was that by abreast Caused aduct. inside blocked Milk • • • You’ll see ik blister. Milk redness Possible or area. nursing. after breast your touch you when Hard or red lump lump red or Hard • • • anyNot feeling better? • • • • • • steps: these follow infection, prevent To infection. an may you get long, too for blocked stays milk the If do? to What persists for more than a few days, see adoctor. see days, a few than for more persists have Motrin bath. warm a having while area affected the massage nurses. she hard area when to the points it that so nose or chin baby’s the direct easily. If possible, If your breast is very red or you start to run afever, to run might you start you or red is very breast your If Start with the sore breast and vary the positions so that milk flows flows milk that so positions the vary and breast sore the with Start breast. affected the from especially often, more baby your Nurse If you do not experience any pain, redness or fever, or lump the redness but any pain, experience not do you If (e.g., Atasol Acetaminophen bra. tight overly Avoid an wearing still, or, facecloth better Use adamp nursing. before just heat wet Apply feedings. 10 ice for Apply to between 15 1to 2hours every minutes nursing. during area affected the massage Gently mastitis ® ) can soothe the pain as needed. pain the soothe ) can . ® , Tylenol ® ) or ibuprofen (e.g., Advil ibuprofen ) or ® , 493 Feeding your child Breastfeeding your baby Mastitis

What is it? What to do? Signs of improvement Not feeling any better?

• Breast infection caused by bacteria. • Continue nursing with the infected breast; the milk is fine. It takes 2 to 5 days for mastitis to clear up. See a doctor if • You are more at risk if • Empty the painful breast as much as possible. Express milk, • The fever generally disappears within 24 hours. • The situation suddenly gets worse – You have cracked nipples if need be. • The pain and redness decrease in under 48 hours. • Your symptoms have not started to improve after 12 hours – Engorgement lasts a long time • Start with the affected breast and vary the positions so that • The hardened area shrinks within a few days. • Your situation stops improving for over 24 hours – You are tired the milk flows freely. If possible, direct the baby’s chin or nose • Sensitivity in the breast may last longer. In some cases, you will need antibiotics. toward the lump when he nurses. • May turn into an abscess. • If nursing is very uncomfortable, start on the other side first Possible signs and change sides as soon as milk is flowing freely from the painful breast. You’ll feel You’ll see • Apply ice for 10 to 15 minutes every 1 to 2 hours between feedings. Breastfeeding baby your Aches, shivers, fatigue Hard, red, warm • • • Take acetaminophen (e.g., Atasol®, Tylenol®) or ibuprofen (flu-like symptoms). and swollen lump or area. (e.g., Advil®, Motrin®) to soothe the pain and reduce fever. Fever. • • Cut back on your activities and try to get more rest. • Breast pain, often worse when full.

If you have cracked nipples or a red area on your breast that is rapidly getting bigger, see a doctor as you will need antibiotics. Feeding child your 494 Mastitis • • • You’ll feel Possible signs • • • it? is What Fever. when full. when symptoms). (flu-like – You tired are time along lasts – Engorgement – You nipples have cracked Breast pain, often worse worse often pain, Breast fatigue shivers, Aches, into abscess. an May turn You if at risk more are by bacteria. caused infection Breast • You’ll see and swollen lump or area. or and swollen lump Hard, red, warm warm red, Hard, • • • • • • • do? to What (e.g., Advil between feedings. breast. painful the from freely is flowing as milk as soon sides and change nurses. he when lump the toward nose or baby’s chin the direct possible, If freely. flows the milk be. if need Cut back on your activities and try to get more rest. more to get try and activities your on Cut back Take (e.g., Atasol acetaminophen 10 ice for Apply to 15 1to 2hours every minutes first side other the on start uncomfortable, is very nursing If so that positions the vary and breast affected the with Start as possible. as much breast painful the Empty is fine. milk the breast; infected the with nursing Continue ® , Motrin ® ) to soothe the pain and reduce fever. reduce and pain the ) to soothe ® , Tylenol ® ) or ibuprofen Express milk, milk, • • • • 2to 5days takes for It Signs of improvement Sensitivity in the breast may last longer. may last breast the in Sensitivity days. afew within shrinks area hardened The hours. 48 under in decrease redness and pain The 24 within hours. disappears generally fever The mastitis to clear up. to clear In some cases, you will need antibiotics. need will you cases, some In • • • if adoctor See anyNot feeling better? Your situation stops improving for over 24 for Your hours improving stops situation 12 to improve after hours Your have started not symptoms The situation suddenly worse gets 495 Feeding your child Breastfeeding your baby 496 Feeding your child Bottle-feeding your baby Cleaning bottles, nipples and breast pumps nipples and breast bottles, Cleaning problems and solutions Bottle-feeding your baby Bottle-feeding Warming milk milk? much How and nipples Choosing baby bottles �� 503 502 498 499 507 501

Nathalie Vandal and choices in the types milkknowYou’ll about to need you find everything • • • • This chapter contains information on: in asimilar to way. baby anduse prepare bottles need of milk you’re of the type Regardless formula. using, you’ll milk breast commercialyour or baby expressed infant to feed used be can Bottles is important. Bottle-feeding

Cleaning bottles, nipples and breast pumps breast and nipples bottles, Cleaning babies Food-related problems for bottle-fed your baby Bottle-feeding nipples and bottles Choosing Milk

chapter on page 382 page on . in the gas, eating behaviour, schedule, etc.) found be can feeding informationGeneral your on feeding baby (burping, Keep an eye your on baby’s behaviour. formula. commercial using infant when particularly nursingis periods, also associated with shorter Bottle afew times. abottle from drinking after find it hardthat some babies to return breast to the If you are breastfeeding your baby, youIf are breastfeeding aware be Feeding your baby Feeding chapter on page 366 page on . ‑ feeding feeding 497 Feeding your child Bottle-feeding your baby Choosing baby bottles Bottles and nipples Various types of bottles are available: glass, plastic or with disposable bags. Broadly speaking, they come in two sizes: 150 ml to 180 ml (5 to 6 ounces) and 240 ml to 270 ml (8 to There are a number of types of baby bottles and nipples. 9 ounces). Each bottle type has its own advantages and Most companies try to sell their products by claiming disadvantages. Choose the type that best suits you. they “prevent colic” or are “closer to the breast.” Such marketing claims have not been scientifically proven. Bottles currently on sale in Canada do not contain polycarbonate, a hard, transparent plastic that can release bisphenol A when it comes into contact with hot or boiling liquids. The Canadian government recently banned the sale and import of polycarbonate bottles to protect the health of newborn babies and nursing infants, even though it acknowledges that the quantities of bisphenol A Bottle-feeding baby your released by bottles are not sufficient to cause harm. All the same, it’s best to buy new bottles and avoid using second-hand ones. Feeding child your 498 gets older, you can choose a faster-flowing nipple. milk flows intomouth their quickly.too As baby your baby is still learning. Many tend to newborns choke when your because best, is aslow-flow nipple For newborns, companies with different nipples Most sell flowspeeds. for your baby. best one before thatthe you find works types different adapting to any You kind. have afew will probably to try have of nipple, while others trouble no type one particular for your baby. find it easier babies Some to drinkwith than another is of nipple better evidence that type one or silicone) scientificThere no is of firmness. anddegrees comeNipples in different materialssizes, shapes, (latex combination will all work for babies. that the breast/bottle itguarantee can nor really the breast; nipple resembles No of nipple, andyour neighbour’s baby might another. prefer baby is unique.Every Your baby kind might one prefer Nipples much ababy may drink in aday. is meant only the followingon page to illustrate how at information agiven in age. the table The need babies into research conducted No how much has milk been your baby’s appetite! Respect he needs. how him fullness muchof hunger or decide andlet milk andwatch signs to for observe It’s best so in the morning. Your in the evening andless hungry baby may very be gradually.increase small. his amount This stomach is will stillbecause very few days,first baby your will a drinkonly small amount day one andfrom to another.baby to the next, the Over amount one of milk from The consumed widely varies milk? much How 499 Feeding your child Bottle-feeding your baby Daily amount of milk: an illustration

Age Daily amount (24 hours)

Within the 1st week Steady increase from 180 ml to 600 ml

1st week until the end of the 450 ml to 800 ml 1st month

2nd and 3rd months 500 ml to 900 ml

4th, 5th and 6th months 850 ml to 1,000 ml

7th to 12th months 750 ml to 850 ml Bottle-feeding baby your

1 oz = 30 ml 1 cup = 250 ml

Remember that tables don’t take into account the individual needs of your baby, who is unique. Observing your baby will likely teach you much more than reading this table. You Maroussia Beaulieu can also ask a doctor, midwife or CLSC nurse for advice, if you feel the need. Your baby is unique. Watch him and he’ll let you know if he has had enough to drink. Feeding child your 500 • • • can continue warming itup. To reheat milk: 12 months, your if but child doesn’t like you cold milk, like water andjuice milk, drinks atrefrigerated 10 to itlukewarm. Childrenbabies prefer usually drinking begin is nutritional no most but reasonThere to heat milk, Warming milk

be neither hot nor cold hot nor to neither the touch.be milkof your the inside hand should or The of your wrist. glass or plastic bottles. lukewarm. until To the temperature, check afew drops the back on pour Shake gently. than heat bags quickly more Disposable Put the milk container in water warm afew minutes for • • • To thaw reheat or frozen milk: breast

then warm itin hot water.then warm wateradd hot until the milk is lukewarm. Stir, itto your the temperature check baby. andfeed the milk 10 put for inOr the refrigerator to 12 hours, Run cold water over the container, gradually then high temperatures. Microwaves heat unevenly, at dangerously often Do not warm milk not warm inDo amicrowave oven. 501 Feeding your child Bottle-feeding your baby Do not warm a bottle of milk in boiling water on the stove. Bottle-feeding your baby All foods—both liquid and solid—lose some of their nutritional value when overheated. And babies have been Feeding will go more smoothly if you bottle-feed your accidentally burned with milk that was too hot or was baby as soon as he shows signs of hunger. heated in a microwave oven. Make yourself comfortable. If need be, slide a pillow Microwave ovens are also unsuitable because there under the arm holding your baby. Tilt the bottle slightly is a risk that bags and glass bottles might explode. Also to keep the neck full of milk and to make sure your baby breast milk loses some of its vitamins and antibodies doesn’t swallow any air. Change positions between when reheated in the microwave. feedings, moving your baby from one side to the other. This will help your baby’s eyesight develop. It’s sometimes Don’t leave reheated milk for more than two hours a good idea to take a break or two while feeding, at room temperature. Throw it away if it is left out for especially in the first few months. this long because bacteria multiply quickly and could

Bottle-feeding baby your cause diarrhea. Feeding child your 502 choke while drinking. while choke may he baby by or chair himself in his because bed bottle to your the let of baby you.both It’s hold not advisable your baby in for your while feeding to arms relax is good your baby. Taking andwarm. makes This safe him feel time with contact hesitate one. Don’t to makelittle skin-to-skin with your to bond time isFeeding agreat opportunity gradually. time to trust andlearn yourself! Give yourself Feeding yourFeeding baby you is how something learn to do • • • • • if she always easy. You sleep her routine follow can andlet her isn’t what’s best Knowing you wake should to her feed. yourIf baby sleeps a lot, you probably wonder whether Your baby lot a sleeps as her and feeding sleeping routine. your baby. Try as temperament well her for to afeel get thing first do isto observe is temporary.the problem The Usually, have feeding. trouble sometimes can Babies and solutions problems Bottle-feeding

on weight Has regained her birth weight andcontinues birth her Has regained to put feeding after satisfied Is calm andseems Pees at 6times aday andpasses least at 3stools least feeder andeffective Is an active Wakes own to her up on feed 503 Feeding your child Bottle-feeding your baby In this case, there is nothing to worry about. Babies each have their own routine that develops over time.

Some babies sleep so much they may skip some feedings, especially during the first 2 to 3 weeks. This means they will have a hard time getting all the milk they need. If your baby sleeps a lot and doesn’t show the signs described above, you need to stimulate her to drink more.

What to do

• Keep an eye out for signs that she’s sleeping lightly (she’s moving, making sucking motions, or moving

Bottle-feeding baby your her eyes beneath her eyelids) when it will be easier to wake her up. • Stimulate her: talk to her, massage her back, legs, arms, etc. • Leave her in an undershirt or diaper: babies drink less when they are warm. Marie-Ève Bolduc Marie-Ève • See a professional if you’re worried or see no You may need to wake your baby up to feed improvement after a few days. her if she sleeps a lot. Feeding child your 504 • • • • What todo get older. however, will continue to drink slowly even as they with time. patient: your Be babies, baby is learning. Some to get the hang of things. situation This usually improves afew daysEven may babies weeks or need full-term pregnancy). 35 of 37 and weeks (between prematurely afew weeks were who born common babies more among This is start. can’tat alwaysBabies the suck effectively Your slowly baby very drinks

few minutes. to stimulate her. andsides. back and tickling her Change her diaper or change her position for a Runher yourchin acrossunder finger and her cheeks Stimulate feet by your her rubbing baby as feeds she Change to nipple. afaster • • • What todo (i.e., she swallows noisily, milk). coughs up alittle andspits baby has too much milk may she mouth, in her choke you the nipple areIf using flows and your quickly too Your chokes drinking while baby often

Your to able baby drink will be at own then pace. her to the nipple for fillwith milknot and air).(just enough is tilted slightly only so that the bottle downward Trynot sucking. in anear-sitting her to position feed since milk will flow intomouth her even she’swhen Avoid laying your during back baby feeding her on Take breaks. feeding short Change to aslower nipple. 505 Feeding your child Bottle-feeding your baby Your baby regurgitates a lot What to do As long as your baby is happy and putting on weight, If your baby is in good spirits and gaining weight, there’s regurgitation (“spitting up”) is generally nothing to worry nothing to worry about. You don’t need to do anything. about (see Regurgitation, page 374). If regurgitation seems to be bothering her, watch Some babies drink very fast, and their stomachs expand her drink. If necessary, try these strategies: too quickly. This makes it easier for them to regurgitate, especially if they are very active and start moving around • Change to a slower nipple. right after feeding. • Take short feeding breaks. If milk is coming out of the bottle too quickly, your baby • Try to burp her more. will drink too much just to satisfy her need to suck. If she Avoid laying your baby on her back during feeding. regurgitates a lot, the nipple on the bottle may be too fast. • Try to feed her in a near–sitting position so that milk

Bottle-feeding baby your will flow into her mouth more slowly. • Try to keep activity to a minimum right after feeding. Feeding child your 506 infections in your baby’sinfections mouth. will help prevent gastroenteritis and prevent fungal This feeding. for used pumpsbreast and other articles nipples, bottles, wash to sure carefully Be formula. infant your baby milk breast feeding commercialclean when or to kept be very need pumpsBreast andbaby bottles nipples and breast pumps bottles, Cleaning bottle and to altogether,or refuses the tips on see to bottle Your baby and you normally want breastfeeds, Your baby bottle the refuses • • • • your if baby adoctor to see It’s best

Isn’t putting on enough weight enough on Isn’t putting Wets fewer diapers several vomits timesProjectile aday to in pain be Seems ‑ feed her? If she has trouble bottle-feeding her?feed has she bottle-feeding If trouble , page 462 , page . Combining breast breast Combining hot milk into as either them they could burst. pour Don’t bagsare too flimsy be reused. Disposable to theyif have are torn change or texture. holes, sticky, or andthrow away them soft become immediately toand exposure sunlight. they Replace before them with milk heat, contact of suction, time due to the effects regularly. the nipples Inspect will wear They over out preparation. contaminated during also have been infant formulas contain such andmay no components that prevent growing from awhile. for Commercial bacteria milk contains cells white andother components blood slightlywhichon milk differentdepending you use.Breast Cleaning recommendations and nipples for bottles are development of thrush in your baby’s mouth. feedings to prevent gastro-enteritis and the and other pumps, items breast for nipples, used It is important to thoroughly wash baby bottles, to wash thoroughly baby bottles, It is important 507 Feeding your child Bottle-feeding your baby Care and cleaning recommendations for baby Once theCleaning bottles is andthe mostnipples important are clean, step you in can caring disinfect for bottles, nipples and breast pumps themthese to items.reduce the number of remaining bacteria. Germs, particularly bacteria, may develop and survive in milk, so be sure to remove all traces of milk from bottles, nipples and breast pumps every time you use them.

Cleaning When:

• After every feeding, clean everything thoroughly no matter what type of milk you use. How:

Bottle-feeding baby your • Immediately after feeding, take • Use hot, soapy water and a nipple and • Rinse in warm tap water. everything apart. bottle brush. Scrub the bottle and • Drain and cover with a clean towel. • Rinse the bottle, nipple and cap nipple well, inside and out. Make sure or breast pump in cold water. Be sure to thoroughly clean all grooves on to run water through the hole in both the plastic ring and the bottle. the nipple to remove surplus milk.

Once the bottles and nipples are clean, you can disinfect them to reduce the number of remaining bacteria. Feeding child your 508 • • • • • • waterIn boiling How: • • When: (sterilization)Disinfection with clean hands. with clean 5to 10for at least minutes. evaporating. water too much bottles. the in trapped are no bubbles saucepan. in a large them put and all parts thoroughly day’s afull feeding. for to use them of have aday you once if enough nipples and bottles your all disinfect Drain and cover with a clean towel. cover aclean and with Drain items the remove and cool Let boil and to aboil water the Bring to prevent Cover saucepan the there Cover care water, in taking clean apart, Take everything You old. is 4months baby until your can feeding every after material your disinfect formula, infant you’reIf commercial using formula. infant or milk commercial breast for it’s whether time, first the for it using before everything Disinfect • • • drying cycle. high have must a dishwasher your dishwasher,To the in items disinfect In the dishwasher not dishwasher safe. are since they water in boiling sterilized (rubber) nipples must be Latex of silicone. they are made provided in the dishwasher nipples put also rack. You can clean thoroughly. energy Put bottles and rings on the upper upper the on rings and Put bottles and Take apart everything the not cycle, this Choose ‑ temperature washing and and washing temperature ‑saving cycle. • nipples and baby bottles With an to appliance sold disinfect Follow the manufacturer’s guidelines. manufacturer’s the Follow 509 Feeding your child Bottle-feeding your baby 510 Feeding your child Water Water problems Water treatment devices Water coolers Bulk water water Bottled Private well water Municipal water tap Choosing the right water 4 months water under Boil babies for to giveWhen your baby water �� 513 512 511 511 517 517 514 516 516 516

Julie Ward foods, offer her a her small offer amountwater of foods, at a time in a cup. to eat Around 6months your of age, baby when starts accordingbeen prepared to the manufacturer’s instructions. has if the formula feedings water between don’t need with commercial fed Babies infant formula generally naturally. to drink water don’t need between feedings. They with their mother’s fed Babies milk quench their thirst baby water When to give your • • • • water: How to andstore boiled prepare page 507) (see water,store boiled way the same you baby do bottles You also must sterilize the containers in which you system, private well, bulk container, or bottle. amunicipal whether itcomes where from, matter no boiled All water given 4months to under be must babies old 4 months under babies for water Boil

containers. add ice to cubes boiling water to it). cool Transfer water into andcooled the boiled sterilized itto giving Cool the water your baby before (do not atBoil rolling at afull 1minute. for least boil Fill with water. apot Cleaning bottles, nipples and breast pumps nipples and breast bottles, Cleaning . , 511 Feeding your child Water You can also use a kettle, but make sure it doesn’t have an automatic shutoff, because the water must boil for 1 full minute.

Boiled water can be kept in sterilized, properly sealed containers in the refrigerator for 3 days or for 24 hours if kept at room temperature out of direct sunlight.

From 4 months on, your baby can drink unboiled water.

Choosing the right water

Some micro-organisms that are harmless to adults can Water cause diarrhea or other illnesses in young children. That’s why the water you give your infant, whether in a cup or mixed in formula or purées, must always be good quality. Plus, it must not contain high levels of mineral salts. Pascale Turcotte Pascale

If you give your baby water before she is 4 months old, make sure it has boiled thoroughly for 1 minute, no matter where it comes from, whether a municipal system, private well, bulk container, or bottle. Feeding child your 512 (e.g., boil water advisory), follow the instructions provided. your issued water about has been water apublic If advisory above). (see table for babies otherfrom some source that has recommended been water, not give do itto your baby. Give your baby water with your cooking or against drinking is a public advisory youIf are unsure of your water there of the quality if or mineralized water) or (excluding mineral water or bulk-packaged bottled Commercial quality standards meets well that aprivate Water from water tap Municipal for infants Water recommended mineralized water Mineral or regularly tested is not quality source whose anatural Water from rivers lakes or Water from for infants Water not recommended

radio, newspapers, personal advisories, etc. recommendations are issued through various outlets: to consumed, be is the public and immediately notified control. water If is quality enough not for the good water Water municipal from water to supplies quality is subject water tap Municipal cold water. contain than contaminants, lead, more andbacteria as it may cooking for yourprepare or baby’s bottles Do not drink warm tap water not drink tap warm notDo itto use anddo 513 Feeding your child Water Private well water

You can use water from a private well (surface or artesian well) as long as recent tests show that it meets quality standards. If it is a new well, the water should be tested for chemicals and bacteria by a lab accredited by Ministère de l’Environnement et de la Lutte contre les changements climatiques. If you own a private well, it is recommended that you have your well water tested at least twice a year.

For the names of accredited labs in your area, visit ceaeq.gouv.qc.ca/accreditation/PALA/lla03.htm (in French only).

Water Tests can detect undesirable elements in your water (e.g., chemicals or microbial contaminants and bacteria such as E. coli). Geneviève Colpron

Before using tap water for consumption, let it run until the water gets cold, then let it continue to run for a a minute or two. This gets rid of any accumulated lead or copper, as well as certain bacteria that are sometimes found in pipes. Feeding child your 514 • • area, you contact can of well you waterIf have the quality in your about doubts eau/potable/depliant/index-en.htm For information, more visit another source of water. consumption to itbefore andcool boil either use or need a microbial contaminant is in the water, found you usually another source of drinking water, like water. bottled When waterin drinking allowable exceed levels, you use must In general, concentrations when of chemical substances

Your municipality well digger A local environnement.gouv.qc.ca/ . water-wells/ resources/drinking-water/contaminants-in-drinking- You also can visit • • • For information, more contact

climatiques. l’Environnement et de la Lutte contre les changements your region les changements climatiques branch responsible for A lab in your area accredited by Ministère de Y M The cold water. contain than contaminants, lead, more andbacteria as it may cooking for yourprepare or baby’s bottles our local public health department health public local our Do not drink warm tap water not drink tap warm notDo itto use anddo inistère de l’Environnement et de la Lutte contre contre Lutte la de et l’Environnement de inistère . quebec.ca/en/environment-and-natural-

515 Feeding your child Water Bottled water Bulk water

Only two types of bottled water are suitable for your baby. If you drink bulk-packaged water, be sure to get it from a recognized or reliable location (e.g., a grocery store). Spring water comes from an underground spring and To reduce the risk of contamination, the containers you contains low mineral levels. It is tested twice for quality— use to collect bulk water should be washed in hot soapy once at the spring and again at the bottling plant. Spring water and rinsed well. In addition, be sure to follow the water that is labelled “natural” has not been treated or distributor’s instructions when filling containers. modified in any way. That said, all spring water (with or without a “natural” label) is good for your baby. Generally speaking, water bottled in Québec is disinfected with Water coolers ozone or UV rays to ensure its microbiological quality. If you use a water cooler, be sure to clean it regularly Non-mineralized treated water is tap water that has

Water according to the manufacturer’s recommendations. Also, been filtered and purified to resemble spring water. It does be sure to keep the cooler spout very clean, as it can be not contain any added mineral salts. easily soiled by children or adults with dirty hands or by pets. Feeding child your 516 instructions. regularly, accordingmembrane manufacturer’s to the properly, to you remember need to change the filter or your you for family,If one use in to addition cleaning it devices areThese also difficult toclean. • • these devices: related of to some risks of the known are some Here deviceswith these to of 6months. the age ababy under devices are. That’s why not to give itis best water treated itis impossible these tohow safe may know practices vary standards. Moreover, Québec meet since use and upkeep However, instructions. manufacturer they not necessarily do according used when standards, to quality certain meet the National Foundation Sanitation (NSF), others, among of their taste water. or by the quality certified Products water home use treatment devices people to improveSome Water devices treatment

amount of some bacteria. amount of some (salt). sodium of amount the increase Charcoal filters without or silver)(with can increase the to water or the tap intake connected Water softeners regional public health department. health public regional contre la de Lutte et climatiques changements les your or Ministère l’Environnement you de contact can resort, Last • • of your water? the quality about Water change can colour, doubts smell, andtaste. Got Water problems

PALA/lla03.htm 1-800-0561-1616 Lutte contre les changements climatiques at accredited by Ministère l’Environnement la de de et local municipality, alaboratory or well specialist, alocal operator. waterworks or municipality contact the If you are connected to aprivate you your well, If are connected contact to amunicipal youIf are water connected supply, (in French only). or visit or ceaeq.gouv.qc.ca/accreditation/ 517 Feeding your child Water 518 Feeding your child Foods From 1 year onward—Sharing meals with the family From the with meals year 1 onward—Sharing your ideas for Food baby Fats products dairy and Milk fruit and Vegetables alternatives and Meat products Grain of foods Continue with avariety foods iron-rich Start with 6 to 12 months—Your foods baby’s first basics Baby food Honey—never for babies under age 1 until careful 4 age extra Be risk: Choking foods? introduce I should How shouldWhen I introduce foods? ��

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Martin Chénier of the same foods as of the family. the rest foods of the same so, 1or eating age will she By be most and textures. Gradually, your baby will new foods develop for ataste It takes to time to eatingexperience. used get foods. Your new whole be a will baby’stastefood of first them in keeping with your baby’s own pace and needs. Introduce formula. infant milk and breast than other presented in this foods chapterThe include everything complement—but not replace—milk. duringyear of the first life.main food Foods can Breast milkBreast infant or your formula will baby’s be and could have adaptingfoods. to difficulty more your baby may all not get the instead of you complementing If wait until it. later, youIf introduce earlier, foods they will replace milk preventThey also help like problems iron deficiency. to grow. need babies energy provide the extra to introduce into foods your foods baby’s These diet. At six months necessary about of age, itbecomes with their milk. needs all their nutritional meet 6months, babies most Before grow. as they change needs nutritional Babies’ foods? introduce I should When nutrients he needs 519 Feeding your child Foods Contrary to popular belief, eating cereal How do I know my baby is ready? at supper does not help infants sleep through It’s not always easy to determine the best time to the night. How long they sleep at night depends introduce foods to your baby since she can’t talk yet. on their biological rhythm and temperament. But it is possible. Here’s how to tell she’s ready: • Your baby is around 6 months old. • Your baby can sit in a high chair without support. • Your baby has good control of her head and can turn away to indicate refusal.

She may also try to bring food to her mouth.

Keep in mind that a baby under 6 months old isn’t

Foods necessarily ready for foods just because she nurses more often for several days. More frequent feedings could be due to a growth spurt or a temporary need for more milk (see Growth spurts, page 372). Feeding child your 520 in milk. likewhile others much so them that they interest lose to foods, used they get several tries before need Some baby greatly varies toInterest one the next. from in food all that much. shouldn’t decrease of milkthe quantity drinks she introducing to your foods baby, you start When earlier than 6months.a little However, eating foods to may start babies some need several days. for often more nurses she because just foods for A baby under 6monthsA baby under isn’t old ready necessarily his system ishis system mature enough. original ensure due date—to born on the been had he the baby the age would be corrected age—i.e., on the based be must foods to when start about The decision key one way as term difference. are—with babies Premature are introduced babies the same to foods What about premature babies? 521 Feeding your child Foods How should I introduce foods?

Order of introduction The order in which foods are introduced varies from country to country, depending on customs and culture.

The important thing is to start with iron-rich foods, then continue with a nutritious variety of foods (see Start with iron-rich foods, page 540).

Note, however, that cow’s milk should not be introduced

Foods before 9 to 12 months.

The important thing is to start with iron-rich foods, then continue with a nutritious variety of foods. Jean-Claude Mercier

Once your baby starts eating foods, continue breastfeeding as often as he wants. If you feed your baby commercial infant formula, give him at least 750 ml (25 oz) of milk a day. Feeding child your 522 food allergies. food allergies, even in children with agreater risk of developing not prevent does foods of these delaying the introduction likely more tofoods causeallergies. We that now know introducing before age acertain reached had their babies that wait until itwas parents recommended In the past, (see page 546) nut butters page 549) likely most to causeallergies foods are eggs The A word about allergies food Milk and dairy products dairy and Milk , peanuts and other nuts andother nuts , peanuts and foods that contain cow’s contain that protein milk foods and , page 549) , fish and seafood , fishseafood and , page 557) (see . Peanut and (see Fish (see , Eggs , the food that is responsible.the food easier allergies, or itwill to be identify of discomfort new.something way, That your if baby shows signs a time to your baby, andto 3days wait adding 2or before to at suggested introduce new food It is one often New foods Talk to your doctor. • or • A child is at greater if allergy risk of developing afood

of eczema most of the time) most of eczema brother, sister) or has an The child suffers from severe eczema severefrom eczema (shows child suffers The signs of his immediateA member (mother, family father, allergic disorder 523 Feeding your child Foods After your baby has tried a new food, watch her. Quantity and frequency To learn more about the signs of an allergic reaction Your baby has a small stomach, so he needs to eat and the steps to take, see How do I recognize allergies?, small portions several times a day. page 572. Your baby’s appetite is your best guide to knowing When introducing new foods, continue to give your baby how much food he needs. The quantity will depend the foods she already knows on a regular basis. on how much milk he drinks and will vary with his growth rate. Don’t insist if your baby refuses a new food for a few days. Try introducing it again later. You may have to present a When your baby starts eating foods, he will probably food a number of times (up to 10 and sometimes even continue drinking about the same amount of milk. more) before your baby accepts it. This is how she learns At around 8 or 9 months, he will gradually start to like new flavours. drinking less.

Foods It’s best to avoid foods with added salt or sugar until your baby is at least 1 year old. This will help her develop When your baby starts eating foods, the number a taste for foods in their natural state. of breast or bottle feedings can stay the same. The amount of milk he drinks will probably not decrease very much. Feeding child your 524 and snacks (between meals andat night, as needed). (between and snacks lunch, supper) meals for (breakfast, regulara more schedule around 1yearBy of age, your child to able will adopt be meals. between snacks a day. Depending how you on much could eats, he add You three could,meals or give example, for him two will increase.meals andsnacks of andthe number the amount by of food little, Little once during more or the day.a few of food small spoonfuls your baby has eat to will he probably At adapt; the start, she is signalling that has to she enough had eat. away, plays or cries, food, turns head, with her her to spoon eat, refuses mouth, pushes her if she closes her you can continue However, hesitation. without feeding you give, is she stillthe food hungry, it’s because and your appetite. If to know her baby shows interest in watchingBy yoursignals, baby specific for you’lllearn textures. or foods eat less, andit’s that possible they may not like certain to babies sometimes for It’s normal day to the next. A baby’s one is appetite from like an adult’s: vary itcan Appetite when she is she full. when appetite. Trust to her will get know your child to know andyour family child the whole pleasant for more be eating independently.starts Don’t insist. Mealtime will It’s that possible your child will eat she less when 525 Feeding your child Foods Texture When first introducing foods, you can start by giving your baby smooth purées.

Some babies will be ready right away for thicker, lumpier purées blended for only a short time or mashed with a fork. Others will find it more difficult to adapt, in which case you can gradually alter the texture from one meal to the next. Foods Pascale Turcotte Pascale

Your baby can gradually start eating soft foods mashed with a fork or cut into small pieces. Feeding child your 526 (see that present with foods arisk of choking careful But be of textures. your baby is to in able avariety eat foods is to goal progress that so The by around 1year of age, chew with his gums andenjoys so. doing to wait until your child has since teeth, already can he cut into is need no smallchopped or There pieces. accept will that rapidly babies isSome finely food Choking risk: Be extra careful until careful 4 age extra Be risk: Choking , page 530) . days in arow, adoctor. see However, several for meal this if at happens every choking. against protects that given. worry, Don’t (gag this reflex) reaction is anormal Your baby was will he cough andspit up the food towere vomit. about cause your can This swallowed. baby to gag, as he if may in of the his back throat lodge being without eating, small of food amounts your babyWhen starts Gagging 527 Feeding your child Foods Independence Babies love bringing food and objects to their mouths. Let your child start eating with her fingers as soon as possible while at the same time keeping a close eye on her. It’s messier and takes more time, but it’s a lot more fun! Encourage her, because that’s how she learns to eat by herself—it’s an important step to becoming more independent!

First meals While some babies have no trouble adapting to meals, others find it difficult. To make things easier, choose a time when your baby is in a good mood. Foods

The movements involved in eating are very different from those your baby uses for nursing. It takes time to learn. Your baby will need several weeks of practice to develop his abilities and tastes.

Carolann Rioux-BeauchampCarolann Your baby can have his milk before or after foods. If you wish, you can give him some of his milk before By around 1 year of age, your child should be able and the rest after. to eat foods in a variety of textures. Feeding child your 528 repeated attempts, consult professional. health a attempts, repeated yourIf baby is over 6months to andstill eat refuses after maybe didn’t she likefood: what you served. days. more You two one or a her different also can offer for andkeep trying meal again at the next to eat, try youIf think your baby is ready, still she but refuses on page 520 If you’re not sure, see your toIf baby eat, refuses may she ready. not be My baby refuses to eat . How do I know my Iknow How do baby is ready? of taste andadaptof taste to change. Your time to sense develop baby her needs

France Tremblay 529 Feeding your child Foods Choking risk: Be extra Certain foods require careful preparation. To prevent careful until age 4 the risk of choking, be sure to • Remove bones from meat and fish Certain foods can become stuck in your child’s throat • Remove cores and pits from fruit or block her airway. Many children choke on food each year. • Cut grapes into quarters Foods that are hard, small, round, smooth, or sticky • Grate raw hard vegetables and fruits like carrots, turnips, present the greatest risk. and apples

Toward age 2, you can start giving your child whole Certain foods present a choking risk for your child apples (peeled) and whole small fruit, except for grapes, up until the age of 4: peanuts, nuts, seeds, hard candy, which you should continue cutting into quarters. cough drops, popcorn, chewing gum, whole grapes,

Foods raisins, sliced sausage, raw carrots or celery, food on toothpicks or skewers, ice cubes, etc. Feeding child your 530 techniques, you read the advice on can is choking. To familiarize yourself with the appropriate will aid A first course teach what you if do to your child children older toAsk follow rules. these • • • • • Rules to prevent choking

Keep dangerous foods out of reach. out Keep dangerous foods Avoid your child feeding in the car. mouth. your in her let childDon’t walk with food run or Sit your child in ahigh chair at or the table. Make eating. sure when your child is always supervised page 718page . precautions preparing when food. To sure prevent be to take choking, certain

Pascale Turcotte 531 Feeding your child Foods Honey—never for babies Baby food basics under age 1 This section features all the information you need to prepare homemade baby purées and purchase Never give honey to a child before the age of 1, even commercial baby food. It also provides instructions as an ingredient in recipes or cooking. Both pasteurized on warming and storing baby food. and unpasteurized honey can cause a serious form of food poisoning known as infant botulism. Remember that your baby will learn quite After age 1, healthy children run very little risk of quickly to eat foods of varied textures. There’s no need contracting infant botulism because their intestines to stock up on large quantities of baby food! contain useful bacteria that protect against the disease.

Foods Never add honey to any food for a baby under age 1—not even during cooking! Feeding child your 532 sugar, lean meat whenever Buy seasoning. possible. or make sure they don’t containfrozen products, any salt, using possible. If andvegetables fruits the freshest Select Purchasing foods you choose. ofit has the containing advantage the ingredients only more, What’s food. commercial than baby expensive value. It andless is tasting, fresher, better varied, more baby providesHomemade food excellent nutritional Homemade baby food as well as each time you change foods. baby food, preparing you start before work area carefully Wash your hands andclean utensils your cooking and Hygiene sugar. juiceif it’s packed in fruit added with no if they contain You salt. however, fruit, canned use can choices andfish meat, arenotgood vegetables, Canned 533 Feeding your child Foods How to prepare vegetable and fruit purées

Sarah WittySarah 1 WittySarah 2 Bourret Amélie 3

Preparing fruit and vegetable purées • If necessary, steam the food item • Purée the food using a fork, (in a vegetable steamer, for example) blender or food processor. You

Foods • Wash all fruits and vegetables or cook in a microwave. can add liquid to obtain the before cooking. desired texture, e.g., fresh water Check if it is done. You should • or cooking water (see Nitrates in If necessary, remove peels, cores, be able to stick a fork into it easily. • vegetables, page 552). pits, and seeds. Cut the fruits and vegetables • It is not necessary to add into pieces. salt or sugar. Feeding child your 534 • • • • • • for your child. Take meat poultry or cooking when precautions certain Preparing purées meat and poultry How poultry, toprepare andfishpurées meat,

the desired texture. the desired easily can when you cut itwith afork. from meat. Purée, adding enough cooking liquid to obtain in ablender. Put the meat poultry or Remove bones. of water.Cook in plenty Meat is cooked enough into pieces. Cut meat poultry or andany visible fat poultry Remove from skin

• • • purées: fish precautionsCertain should also taken be preparing when Preparing fishpurées

the cooking liquid. any adding without salt. Break up the fish with a fork or purée it with with it Breakpurée up the fishor withfork a remove any bones. Carefully Cook fish waterin stoveon the or in microwave,the after cooking. Don’t add salt or other seasoning or during salt or add Don’t 535 Feeding your child Foods How to freeze homemade purées Commercial baby food Whether jarred or frozen, commercial baby food has If you want to make purées in advance, it’s best to good nutritional value. It’s very practical since it’s always freeze them immediately after preparation. To do so: ready to eat, but it costs more than homemade baby • Pour the purée into ice cube trays while it is still warm. food. Some commercial baby food contains unnecessary ingredients like starch, sugar, flour, tapioca, or cream Cover and cool in the refrigerator. • that decrease the nutritional value. Read the list • Put the ice cube trays in the freezer for 8 to 12 hours. of ingredients on the packaging to choose products without unnecessary additions. • Transfer the frozen purée cubes to a freezer bag. • Remove the air from the bag. Purchasing commercial baby food • Write the name of the food and the cooking date Vegetable-meat combinations – These can be handy on the bag and then put it in the freezer. on occasion, but don’t contain very much meat. Frozen

Foods products generally contain more meat than jarred ones. To find out how long you can keep purées, seeStoring If you choose meat-only purées, it will be easier baby food, page 539. for you to estimate how much meat your child eats and serve the vegetables of your choice. Feeding child your 536 meals with the family. sharing this age, your After childold. simply can start salt and should not given be to children under 12 months contain products These meals. are also ready-to-eat There results by with afork. mashing foods can achieve you because same of limitedthe benefit that However,to eats. the family regular food they are to designed facilitate the transitionof food baby food from “Junior” purées – These purées contain purées small– These pieces indicated in the frozen the period Commercial for be can baby food • • • poisoning: of food are afewHere steps to take to in order eliminate the risk Handling commercial baby food

and refrigerate the rest immediately. the rest and refrigerate date and date with the closest the use jars first. you them. open glass, when notnoise make do or or chipped apopping Put only as much food asPut you as only will much in use food asmall bowl according jars Store to unopened the best-before anyThrow return or out that jars have lids rusted Storing baby food

table on on table page 539page . 537 Feeding your child Foods Warming baby food Whenever possible, warm only as much baby food as you will need. Before feeding your child, always check the temperature using the inside of your wrist or the back of your hand. To limit the risk of contamination, throw out any leftover baby food.

To warm fresh or refrigerated baby food, use one of the following three methods: • Put the purée on the stovetop in a small saucepan or double boiler and warm over low heat. • Put a small amount of food in a glass bowl and let it warm slowly in hot water for a few minutes. Foods • Put the food on a small plate and heat it in the microwave. Carefully read the section on microwave precautions. Pascale Turcotte Pascale

Make sure family members and babysitters fully understand how to warm baby food. Feeding child your 538 • • • precautions: certain to take important Microwaves evenly. not heat do food That’s why it is Wait around 30 seconds. Before serving the purée, the purée, Wait serving around Before 30 seconds. Stir itwell once itis warm. Warm in asmall, the baby microwave-safe food dish. or the insideor of your wrist. the temperaturecheck using of theyour back hand Microwave precautions according below: to life indicated in the storage the table stored andcommercial be can Homemade baby food Storing baby food Meat with vegetables fish poultry, Meat, Vegetables and fruit Type food of Do not refreeze thawed food. not refreeze Do 1 to 2days 1 to 2days 2 to 3days Refrigerator 1 to 2months 1 to 2months 2 to 3months Freezer 539 Feeding your child Foods 6 to 12 months—Your baby’s first foods

Start with iron-rich foods A vegetarian diet may be suitable for your baby if it is well balanced. However, if too many foods are excluded, your baby’s diet may be lacking in certain nutrients. It’s Your baby’s first foods should be rich in iron. best to see a nutritionist about this. Why? Because iron plays a number of key roles in her development. Between 6 months and 1 year, give iron-rich foods Iron is found in to your baby at least twice a day. After, serve some • Iron-enriched baby cereal at each meal. • Meat and poultry Foods • Fish Good to know… Tofu • Fruits and vegetables are rich in vitamin C, which helps • Legumes the body absorb iron. Introduce them early into your baby’s diet. • Eggs

Choose foods based on you and your baby’s preferences. Give him iron-rich foods at least twice a day. Feeding child your 540 can be found after page 576. page after found be can your baby toFor ideas on foods give your baby, see group. the next on starting group before same food You don’t need to introduce the from all of the foods not drink cow’s of 9months. the age milk before please. Remember, however, that your baby You introduce can in whatever new foods you order into of foods diet. her several for days,foods it’s time to agrowing add variety eating your iron-rich more or baby has one been After of foods C ontinue with a variety ontinue avariety with on page 560 . Atear-off of thistable version Food ideas for should • • • • groups: food four the about information you’llIn the upcomingpractical pages, find of foods. variety Toward of 1year, the age your child eating will be awide groups within afew weeks. Ideally, all your the food from baby eating will be foods

Milk and alternatives and Milk fruit and Vegetables alternatives and Meat products Grain 541 Feeding your child Foods Grain products Choose sugar-free cereals. Carefully read the ingredients list on the packaging. Sugar hides behind many names, including dextrose, maltose, sucrose, This food group includes grains like oats, wheat, barley, inverted sugar, glucose polymers, fructose, syrup, rice, buckwheat, rye, millet, and quinoa. It also includes and honey. pasta and bread. How to prepare cereal Iron-enriched cereals To prepare cereal, use breast milk or infant formula. Iron-enriched baby cereals not only contain iron, Some cereals already contain powdered milk, but other vitamins and minerals as well. They are among in which case all you have to do is add water. the first foods that should be introduced. It’s important not to add sugar to cereal. How to choose cereal Serving cereal or any other food in a baby bottle

Foods Start by giving cereals containing only one type is not recommended. of grain (e.g., barley).

At the beginning, opt for cereals containing no fruit, vegetables, or other additions. Feeding child your 542 different flavours of cereal. Later, you flavour can baby the buy or fruit cerealwith that your child milk. with her is already nourished increase overGradually the quantity time. Keep in mind continue untiladapting is she her appetite. satisfied, to with liquid andgive itto your baby. readily she accepts If it, by 3to mixing 5 ml ( Start started get to How 1/2 to cereal 1 teaspoon) of dry foods you introduce should foods to your baby. Iron-enriched baby cereals are the first among Iron-enriched

Pascale Turcotte 543 Feeding your child Foods Other grain products If your baby accepts different textures, offer her foods like toast, pita bread, naan bread or chapati, tortillas, Once your baby is eating iron-rich foods at least twice breadsticks, unsalted crackers, unsweetened oat ring a day and has a varied diet, you can introduce other cereal, and all types of pasta. grain products. Be careful with rice because your child can choke on it. It’s best to opt for whole grain products like whole It’s best to start with sticky, short-grain rice and mash wheat bread and pasta. They contain more fibre, it with a fork. which ensures your baby has regular bowel movements. To help you choose, read the list of ingredients: the first ingredient must be a whole grain (e.g., whole grain oats or whole wheat flour). Foods Feeding child your 544 to your baby. you introduceshould foods they are the first among they are rich in Because iron, tofu, and eggs. as legumes, proteins: poultry, meat, fish, alternativesand such that group is up are of foods made rich in food This Meat and alternatives your baby. you introduceshould foods the first among to Meat andalternatives are are rich in iron.They your child’s appetite and preferences. meals, gradually increase the quantity, into taking account at or the meal of meat poultry. subsequent or During by your giving babyStart 3to 5 ml ( started get to How pieces. bite-sized meat or and juicy tender chopped finely as your baby learns to chew. For you serve example, can the texture gradually then modify purées, serve meat well cooked. To be must All meat andpoultry begin, poultry and meat prepare to How zinc. and iron especially minerals, certain and turkey, etc.) provide protein. also provide vitamins They veal, (chicken, lamb, etc.)Meat (beef, pork, and poultry and poultry Meat 1/2 to 1 teaspoon) 545 Feeding your child Foods Game meat Fish You can also serve game meat, though it’s preferable Fish is a source of protein, iron, vitamin D, and good fat. to serve game killed with lead-free ammunition. Lead can negatively affect children’s development. In the past, parents were recommended to wait until babies reached a certain age before introducing fish. Do not give your child organ meats (e.g., liver, heart) We now know that this does not prevent allergies. from game animals, as they are often contaminated.

Deli meats Are you concerned about allergies? Read A word about food allergies on page 523. It’s best to avoid deli meats (e.g., ham, sausage, pâtés, salami, bologna, mock chicken, bacon) because they contain nitrates, and nitrites that can be harmful to your child’s health. If you decide to serve deli meats

Foods to your family and to your child when he is older, choose those that are the leanest and contain the least amount of salt and spices. Feeding child your 546 seafood at the supermarket and inSee fish markets. You of fish your baby manyavailable serve can of the types baby’s diet. hesitateDon’t to of makeyour fishpart a regular , page 88 . Fish and and Fish light tuna not (but white tuna). fish unsaltedlike canned or salmon occasionally serve salty. fish However, Canned is usually very can you sometimes contain. young children are sensitive more to the parasites they Don’t giveDon’t raw smoked fish or to your child, since 547 Feeding your child Foods Legumes and tofu Opt for regular tofu (firm, semi firm, or extra firm) rather than soft tofu. Soft tofu contains more water, Legumes and tofu are a nutritious and inexpensive. and therefore has less protein and iron. They are a good source of vegetable protein and iron. Legumes are also rich in fibre. Tofu can easily be mashed with a fork or crumbled and mixed with vegetables. There are many kinds of legumes, including lentils, chickpeas, kidney beans, black beans, white beans, etc. Serve them in purées, mashed with a fork, or in soups. Foods Feeding child your 548 and never raw runny. or Make sure well the egg is cooked, or in an omelette. scrambled, white). poached, hardboiled, eggs Serve You give can (the your eggs child whole yolk andthe whites. We that now know this not prevent does allergies. introducing before egg age acertain reached had babies to were wait until parents recommended In the past, their Eggs are nutritious, convenient, and inexpensive. Eggs about food allergies food about Are allergies? you concerned about Read , page 523 . A word word A butter by the spoonful either. the spoonful butter by to It is not safe give your hazard. childa choking nut theybe given to present children 4because age under Crunchy and peanuts, nuts nut should butters, not toast. warm on You spread thinly your child smooth nut butters, serve can We thatfoods. now know this not prevent does allergies. introducing before these age acertain reached had babies to were wait until parents recommended In the past, their Peanut and are nut convenient butters and nutritious. Peanut and nut butters

549 Feeding your child Foods Vegetables and fruit

Vegetables and fruit are vital for good health. Not only do they add a wide variety of flavours to your baby’s diet, they also provide minerals and vitamins like vitamin C. They are rich in fibre, too, which helps your baby have regular bowel movements.

After a certain time, you can make fruits and vegetables part of every meal. For example you can serve vegetables at lunch and supper, and give your baby fruit at breakfast and for dessert. Fruits and vegetables also make good snacks. Foods Sophie Roy Sophie

Once your baby is eating iron-rich foods every day, you can add fruits and vegetables to her diet. Feeding child your 550 vegetables cut into pieces. vegetables little Your to baby will eating used gradually get cooked with afork. mashed or in purée You by introducing served begin can cooked vegetables How to prepare vegetables green peas, green beans, peppers). squash, yams) (e.g., vegetables dark green or broccoli, (e.g., vegetables orange carrots, to serve regularly it’s good nutritious. For more are this generally reason, vegetables colourful More of vegetables. Give your baby avariety Vegetables Give your child a variety of vegetables. Give your child avariety

Pascale Turcotte 551 Feeding your child Foods Nitrates in vegetables Fruit In the past, parents were recommended to wait before Give your child a variety of fruits. You can use fresh introducing nitrate-rich vegetables like carrots, beets, or frozen fruit. Commercial canned fruit and compotes turnips, and spinach to their babies’ diet. It was also are also convenient. Choose brands without added sugar. recommended to not use cooking water from these vegetables, especially carrots, to prepare purées. How to prepare fruit You can start with soft fruit in purées or mashed with It’s true that nitrates can cause health problems in very a fork (e.g., banana, pear). You can also cook fruit to make young babies. But if you introduce these vegetables compote (e.g., apple, peach). Don’t add sugar when toward the age of 6 months—not before—and give your preparing fruit. If the fruit is very ripe, you can cut it into baby a variety of vegetables, there is no cause for concern. pieces that your baby can eat with her fingers. Foods Feeding child your 552 cooked apples. apples. cooked clementine, or andgrated lightly or of orange, grapefruit, give your small child cut into pieces grapes quarters, cut into cherries plums, or small You pieces. also can Later, likefruits yourmelon, baby firmer you serve can into small pieces. cut or with afork mashed also can be blackberries Berries like strawberries, raspberries, blueberries and Give your child a variety of fruits. of fruits. Give your child avariety

Pascale Turcotte 553 Feeding your child Foods What about fruit juice? Good to know… Most children like juice. But it’s important to remember Fruit juice has a number of disadvantages: that fruit is more nutritious than juice because it contains fibre. In fact, fruit juice is not essential. To quench your • It increases the risk of early childhood tooth decay, child’s thirst between feedings, water is the best choice. since it naturally contains sugar. • There is a risk of it replacing milk and foods essential to your child’s health and development if given in Fruit juice is not essential. To quench your child’s too great a quantity. thirst between feedings, water is the best choice. • It can spoil your child’s appetite if served within an hour of mealtime. • It can cause diarrhea if it is served in too great a quantity. Foods Feeding child your 554 • • • • tips: are afewHere helpful youIf give your child fruit juice…

This will help protect her teeth. her willThis protect help (4 to 6 oz) day. per of juicethe quantity to of 125 amaximum to 175 ml Serve juice aday. than more no once twice Serve or Don’t let your child drink juice for periods. prolonged juice inNever ababy bottle. serve Wait until your child is at 1year least andlimit old on page 615 your childDoes like juice too much? See sensitive toare bacteria. very these either. may Young They contain bacteria. harmful children store are not pasteurized chilled juices in the grocery sold Certain the producer is from not pasteurized. directly Avoid juice. unpasteurized Freshly juice bought squeezed value and are with sugar. made fruit-flavouredpowders—they have nutritional little as well andpunches, as cocktails Avoid drinks, fruit since it’s as regular juice the same expensive. more only sugar. juice There’s to special buy babies, for need no 100% pasteurized, Choose juice pure fruit added with no Avoid your giving child juices. unpasteurized . Beware of sugar sugar of Beware 555 Feeding your child Foods Foods Patrick Hénault Patrick Feeding child your 556 more efficiently. with vitamin D, calcium use which the body helps healthy bones Cow’s andteeth. milk is also enriched maintain and build help They calcium. including minerals, and protein contain cheese and yogurt, Milk, are covered chapters of in the first milks other and formula, commercial infant Breastmilk, covers andcheese. cow’s section This yogurt, milk, products dairy and Milk Feeding your child your Feeding . pasteurized milk pasteurized are pasteurized products and dairy fats to grow anddevelop properly. Make sure that milk low Your options. fat “light” or these child needs rather than products milk anddairy high-fat Choose aday. at twice least foods eating iron-rich started You once has he andcheese give can your baby yogurt , page 413) . (see Why serve 557 Feeding your child Foods Cow’s milk: not before 9 months Between 9 and 12 months, once your baby is eating a varied diet including iron-rich foods, she can gradually start drinking pasteurized 3.25% cow’s milk (3.25% milk fat). For more information, see Other types of milk, page 409.

Cheese Choose pasteurized cheeses.

Start with cheeses that can be eaten with a spoon, like cottage cheese or ricotta.

Foods Next introduce grated or thinly sliced hard cheeses (mild and white). Sophie Charest

Since cow’s milk can reduce your baby’s appetite for other foods, including iron-rich foods, don’t give her more than 750 ml (25 oz) per day. Feeding child your 558 (3.25% milk fat). milk you whole use If make your own yogurt, children. young needs of Low yogurt. high-fat for opt products, with all dairy As contains sugar sugar or substitutes. added yogurt Commercial fruit. of pieces fresh or fruit fruit pureed to which you add can to plain yogurt, choose It’s best Yogurt ‑ fat and fat-free yogurt are not suitable for the the are for not suitable fat-freefat and yogurt or nonhydrogenated margarine. or nonhydrogenated margarine. oilsto use vegetable like oil, olive canola or it’s preparation, best andfood For cooking to limit in is them his need no diet. There Fats andoils are essential to your child’s development. Fats 559 Feeding your child Foods Food ideas for your baby

Grain products Meat and alternatives

Iron-enriched baby cereals  Eggs Meat and poultry  Oat  Soy  Beef  Barley  Mixed (multigrain)  Chicken Fish  Rice  Lamb  Brook trout  Pork and other trout  Turkey  Cod Other grain products  Veal  Haddock  Barley  Halibut  Chapati, naan bread, pita bread, tortillas  Salmon  Couscous  Sole  Tofu  Cream of wheat  Tilapia  Millet Foods  Oatmeal  Quinoa Legumes Smooth nut butters, plain  Pasta  Chickpeas  Peanut butter  Short grain sticky rice  Edamame (soy beans)  Almond butter  Toasted bread  Lentils  Unsalted crackers  White, black,  Unsweetened oat ring cereal or kidney beans

 ��  ��  ��  ��

Other  �� Other  �� Feeding child your

560 Note: Generally speaking, the foods in this table are presented in alphabetical order and not in order of introduction. Vegetables and fruit Other                      Zucchini Turnip Tomatoes Squash Potatoes Peppers Onions Mushrooms Corn Cauliflower Carrots Broccoli Avocado Asparagus �� Vegetables Yellow beans green and potatoes Sweet peas)Peas (baby sprouts Brussels                   Strawberries Raspberries Pears Peaches Oranges Melons Mangos Grapes Grapefruit Clementines Cherries Cantaloupe Blueberries Blackberries Bananas Apples Apricots Fruit Plums, prunes prunes Plums, Milk and dairy products products Milk and dairy Other        Gouda Gouda Cheddar Ricotta Cottage 9 and 129 and months between introduced be Can �� Mild hard cheese Mild Fresh cheese Find the tear-off version of this table after page page Find the tear-off576 of after thistable version

  

(3.25% fat) milk milk goat’s cow’s or milk Pasteurized Plain yogurt Plain Kefir

561 Feeding your child Foods From 1 year onward—Sharing meals with the family

Your child now has a highly varied diet that includes almost all the same foods your family eats. He shares the three main meals of the day with you and probably needs one or two snacks as well.

At this age the growth rate starts to slow down a bit. His appetite may decrease or vary from day to day.

Because your child loves to explore and play, he may also be less interested in food. Although this change

Foods worries many parents, there is no need for concern as long as your child is healthy and happy, having fun, and developing normally. Cindy Eng

By age 1 or so, she will be eating most of the same foods as the rest of the family. Feeding child your 562 groups pages. shown the preceding on at three food of the four least from to include foods try way meal, to at good provide every abalanced diet: One (e.g., of salt bit sauce) spaghetti sugar or (e.g., muffins). little a containing dishes and foods homemade him giving meals as of the family. the rest the same You start can much as possible,As accustom your child to eating Developing habits good Go to Go family. the whole ideas balanced meal which for presents You take can inspiration the from child’s on his based needs, preferences and appetite. food-guide.canada.ca/en/food-guide-snapshot/ What matters is to adapt food quantities is to adaptWhat food matters to your Food GuideFood Snapshot , . 563 Feeding your child Foods Foods Nicole April Nicole Feeding child your 564 or you risk spoiling your child’s other foods. for appetite than more 750 don’tBut serve ml (25 oz.) of milk aday page 380) they need milk (3.25% milk D of fat)the vitamin aday to part get children (16 drink should 500 ml cow’s oz.) of whole Cow’s milk D. with vitamin is enriched At around 1year, Good toknow . (see Vitamin D: Not your ordinary vitamin! Not D: Vitamin … , The pleasure of eatingThe together!

Amélie Bourret 565 Feeding your child Foods Ingredients to limit It’s best to prepare homemade meals using simple, minimally processed ingredients. For example, Some ingredients can be bad for your baby and other choose plain rice instead of prepared rice containing family members if consumed in excess. Limit consumption added ingredients. of the following: • Salt • All forms of sugar (sucrose, glucose, fructose, etc.) • Sugar substitutes (e.g., aspartame, sucralose) • Fats and oils containing harmful fats (shortening, hydrogenated oils, coconut oil, palm oil, palm kernel oil, etc.) Foods Feeding child your 566 • • • • • easier family meals Making

devices andtoys. and milk desserts. andmuffins, cookies homemade fruit, yogurt, meal. the in interest maintain This will help to other dessert family members. before serving getting discouraged. Serve nutritious desserts like fruit salad and stewed like andstewed salad fruit nutritious desserts Serve main course the Wait finished has child until your the plate. force on Don’t your child to eat everything to keep your child small from portions Serve At mealtime, avoid such as electronic distractions services available CLSC. in your your local services area, contact childrenfor 2years of age. under To the out findabout CSLCs may various nutrition offer and diet-relatedservices services CLSC 567 Feeding your child Foods Foods Feeding child your 568 Cécile Fortin 569 Feeding your child Foods 570 Feeding your child Food-related problems Constipation Stools and foods babies Chubby Poor appetite Anemia intolerance Lactose allergies Food ��

�� 584 580 579 586 586 583 571

Caroline Cloutier do not trigger an immune system reaction. an immune trigger do not system intolerances isintolerance allergy that food andfood food intolerance. differencebetween as a food The arebut allergic not necessarily to is This known them. childrenSome may to foods, able tolerate not be certain to always take It’s allergies important that seriously. food. never must eat food to allergy aparticular with aknown allergiesSome are serious. A permanent child and very allergy. tofood from is a he said suffer eats, he food that achild’sWhen allergies Food immune system reacts to a particular to aparticular reacts Talk to your doctor. • or • A child is at greater if allergy risk of developing afood Is my child at risk of developing allergy? afood

of eczema most of the time) most of eczema brother, sister) or has an The child suffers from severe eczema severefrom eczema (shows child suffers The signs of his immediateA member (mother, family father, allergic disorder 571 Feeding your child Food-related problems Preventing allergies How do I recognize allergies? In the past, it was recommended that parents wait until An allergic reaction can be sudden and severe, or it their babies had reached a certain age before introducing can be delayed. foods more likely to cause allergies. We now know that delaying the introduction of these foods does not prevent Sudden and severe reactions (known as anaphylaxis) allergies, even in children with a greater risk of developing usually occur anywhere from a few minutes to food allergies (see A word about food allergies, two hours after eating the food in question. Such page 523). reactions are rare. See the red box (page 573) for the most common symptoms. Don’t hesitate to consult a doctor if you have concerns. Food-related problems Food-related Feeding child your 572 him the food in question andconsult in question him the food adoctor. your allergy, childsuspect that has afood giving stop in children but they longer you last with allergies. If atAny symptoms times, these child experience can andexcessivein the stools, irritability. common include blood diarrhea, symptoms The most are harder They to in diagnose. question. the food occur can several eatingDelayed reactions days after He could havingHe be asevere allergic reaction. • • • • accompaniedon the skin by any of the following: Sudden vomiting Sudden breathing Difficulty Swollen lips or tongue A sudden and severe change in his general consciousness) condition (e.g., irritability, drowsiness, loss of Call Call 9-1-1 if your if child develops patches red 573 Feeding your child Food-related problems Breastfed babies and allergies If your breastfed baby has certain symptoms (e.g., excessive crying, blood in stools, repeated refusal There is no evidence linking the food breastfeeding to feed), she may be intolerant or allergic to something mothers eat with the risk that their babies develop food you eat (see How do I recognize allergies?, page 572). allergies. Even if other members of the family have food allergies, you don’t need to stop eating allergy‑causing foods when you’re breastfeeding.

Babies are not allergic to breast milk, since it is perfectly adapted for their intestines. In rare cases, however, some babies may have an allergy to protein from a food their mother is eating that passes through their milk. Such proteins can come from a variety of foods, most often dairy products. Food-related problems Food-related Feeding child your 574 • • • by elimination your baby is to see whether allergic: again. Tryif you eat the same food proceeding as you eliminate will your but react itfrom diet, as soon better will he feel food, you eat a particular to your milk your breast If baby after reacts What todo

the food in question again. in question the food If your baby is feeling better after 7 days, try eating 7days, try after yourIf baby better is feeling Keep an eye your on baby’s behaviour. 7days. for Stop food eating the suspected the food, it’s best to consult it’s best the food, adoctor. there is realIf no improvement you eliminate after • • •

a nutritionist. She can advise you. advise She can a nutritionist. eating from it. Refrain to food. that particular If you need to make youIf need changes to what you eat, consult reappear, the symptoms If itmeans your baby is reacting Keep an eye your on baby’s behaviour. 575 Feeding your child Food-related problems Severe allergies If your child has an epinephrine injector (e.g., EpiPen®), make sure you know when and how If your child has a severe allergy, you will have to be to use it. Explain the allergy symptoms to babysitters very vigilant. If you buy prepared meals, read ingredient and post the emergency procedure to be followed lists carefully to be sure they don’t contain the product in a visible location. Have your child carry a card your child is allergic to. When dining out, ask what’s or wear a bracelet (e.g., MedicAlert®) indicating in the dishes you order for your child. her allergy. For more information contact Allergies Québec at 1-800-990-2575 / 514-990-2575 or visit allergiesquebec.ca (in French only). Food-related problems Food-related Feeding child your 576 Amélie Bourret 577 Feeding your child Food-related problems Food-related problems Food-related Feeding child your 578 a doctor confirms intolerance.the a doctor unless products to lactose-free buy There is no need intolerance is rare inLactose children 3. under and to the of calcium. absorption to the development of children’s systems nervous contributes It cow’s milk formula. commercial infant and is asugar present in all milk—breastLactose milk, that we hear alot about. intolerance intolerance of food form is one Lactose L actose intolerance actose Lactose intolerance is rare inLactose children 3. under

Julie Desrosiers 579 Feeding your child Food-related problems Anemia Warning about cow’s milk

Babies who are fed cow’s milk before the age of Iron deficiency anemia is a fairly common problem 9 months can become anemic because among babies between the ages of 6 and 24 months. It must be treated as it can harm your baby’s health • Cow’s milk can cause blood loss in the delicate and development. intestines of infants. Cow’s milk reduces absorption of iron from To prevent anemia, make sure your child’s diet includes • other foods. iron-rich foods at each meal. Iron supplements are not necessary, except in the case of premature babies. • Cow’s milk in your baby’s diet reduces intake of other foods rich in iron. Symptoms of iron deficiency in children include lack of energy, poor appetite, irritability, difficulty concentrating, Once your baby is over 9 months and is eating a slow weight gain and recurrent infections. However, these variety of foods, she can drink cow’s milk without the Food-related problems Food-related symptoms can also indicate other health problems. When risk of developing anemia. However, she should not in doubt, consult a doctor. drink more than 750 ml (25 oz) of cow’s milk per day. Feeding child your 580 • • • • • • sources are of the best iron: foods The following Your baby’s daily contain should rich diet in iron. foods Preventing anemia

Eggs Legumes Tofu Fish poultry and Meat baby cerealIron-enriched • • • C: of vitamin sources are good andvegetables following fruits The meal. that are foods rich Cat in vitamin every to idea serve good It’s a foods. iron absorb from the body Chelps Vitamin

(green, red or yellow) or (green, red mandarin orange) Cabbage, cauliflower,broccoli, Brussels pepper sprouts, Strawberries, cantaloupe, mango, melon, pineapple kiwi, Citrus (orange, fruits clementine, grapefruit, tangerine, 581 Feeding your child Food-related problems If your child refuses to eat baby cereal, try different Baby-cereal cookies kinds or add fruit. (for ages 1 and over) If she accepts different textures, you can also try giving • 125 ml (1/2 cup) butter, margarine or oil her cereal O’s for children. • 125 ml (1/2 cup) sugar or fruit purée (e.g., apple, date, banana) You can also add baby cereal to recipes for pancakes, • 10 ml (2 tsp.) vanilla muffins, cookies and other baked goods by replacing • 1 egg, beaten half of the flour with iron-enriched dry cereal, like • 150 ml (2/3 cup) white or whole wheat flour in the recipe below. • 150 ml (2/3 cup) iron-enriched baby cereal • 5 ml (1 tsp.) baking powder • 1 pinch of salt • 30 ml (2 tbsp.) cocoa powder (optional) Preheat oven to 190°C (375°F). Grease two cookie sheets. Food-related problems Food-related Cream butter with sugar or fruit purée. Gradually add vanilla and beaten egg. In another bowl, mix remaining ingredients. Carefully add the dry ingredients to the liquid ingredients. Shape into 24 balls and place on cookie sheets. Flatten with a fork.

Bake for 10 minutes. Feeding child your 582 amount of food. of amount thanmealtime fun to insist that your child eat aspecific to make family It is important more his needs. to satisfy your child is growing normally, he is eating enough problemsSerious food-related are rare. So long as slowingfatigue anormal of growth. or due tobe overexcitement, fascination with new discoveries, in appetite children can poor times, Other of medication. by throat, sore caused teething the effect or is discomfort reducedexperience appetite. Sometimes the reason Children, like may adults, havethey when periods Poor appetite are being met. being are nutritionist whether your child’s nutritional requirements supplements. in When doubt, ask your or a doctor mineral or vitamin Normally, need shouldn’t your baby meals. too muchgiving juice milk or between andwater. cheese vegetables, fruit, Avoidmeal. Serve small so you don’tyour spoil child’s the next for appetite sizes serving meals, but keep between snacks Offer him leave let then deal of it, a big the table. simply remove his plate scolding without him making or time, If your child hasn’t acertain eaten after anything in what at order. of the meal. the end served Milk be can him Let how choose much to wants he eat foods. and Give your child small of age-appropriate servings healthy scolding him. without food of wasted and a bit by himself. Learn to accept his pace, his clumsiness to do things wants he the more gets, he older life. The Take what’s in on your going the time child’s to observe What todo 583 Feeding your child Food-related problems Chubby babies In fact, breastfeeding actually reduces the risk of obesity in children. Continue breastfeeding as long as you like. There is no evidence to suggest that chubby babies Take the time to observe your baby. Learn to recognize become obese adults. In most cases, baby fat will her needs (often emotional) and fulfill them with other disappear as your baby grows. Don’t worry if people means than food. Try not to reward or punish your baby comment on your baby’s plumpness. with food. And don’t worry either if your breastfed baby seems chubby during the first few months. It won’t last! Food-related problems Food-related Feeding child your 584 François Laplante 585 Feeding your child Food-related problems Stools and foods Constipation

Babies who eat a variety of foods will pass stools that If your baby has infrequent bowel movements vary in colour and consistency, depending on what during her first few weeks of life, she may not be drinking they have eaten. New foods such as fruits or vegetables enough milk. may result in soft stools for a few days if the food is not completely digested, and they may be a different colour After the age of 6 weeks, babies don’t absolutely have than usual. For example, a baby who eats green to have a bowel movement every 24 hours. Your vegetables may pass green stools. baby may sometimes go several days without a bowel movement. If this is the case and her stools are soft, Don’t worry if your baby’s diaper contains bits everything is normal and there is no cause for concern. of vegetable or fruit. This is common and normal. Food-related problems Food-related Feeding child your 586 or so does not preventor so does constipation. juice of 6months or the age Introducing before food constipation. not cause does formula infant commercial in contained Iron Good toknow complicate the problem. which can further fissures anal can cause (small tears), stools Hard hard and dry, constipated. is she probably However, are is she if small, stools in pain andher worry, either.no need to movements? her stools If appear normal, there’s your during babybowel andturn red strain Does … any relief. you if don’t think your adoctor baby is getting See your baby water 6 months of about is not recommended infant formula, your giving baby the age water before youWhether or using are breastfeeding commercial • • tips: helpful following the to suffering, try yourIf be baby appears What todo infant formula) milk-fed (breast or commercial milk Babies under 6months who are exclusively

amount of water, as recommended on the label. make sure you are diluting the formula with the proper enough milk? formula infant or commercial If your baby is being fed with commercial yourIf baby fed is being infant formula, milk breast enough Make is sure drinking yourbaby , page 370) , page 511) . . (see Is your baby drinking drinking your baby Is (see When to giveWhen 587 Feeding your child Food-related problems Babies 6 months and older who are Never give your baby a laxative or commercial eating food fibre supplement without medical advice. No single food causes constipation. It’s usually the lack of fibre in food that is responsible.

What to do

If your baby appears to be suffering, try the following helpful tips: • Give your child foods that are rich in fibre: – Fruits (including prunes, pears, and apples) – Vegetables Food-related problems Food-related – Whole grain products – Legumes • Give her water in addition to milk. This is especially important if you are giving her more fibre.

If the constipation persists, your baby vomits, has blood in her stools, or is not gaining enough weight, see a doctor. Feeding child your 588 Linda Perron PHOTO(S) PLEINE PAGE PLEINE PHOTO(S) 589 Feeding your child Food-related problems