If you’ve just had a baby, your pharmacist has plenty of advice on all aspects of infant health, including how to resolve feeding and weaning problems. Here Thoai Nguyen, pharmacist at Park Pharmacy in London, answers the most frequently asked questions about infant nutrition.
Q: What is colic and how is it treated?
A: Infant colic is a common condition that’s usually recognised by an infant’s inconsolable crying and drawing up their legs, which often last for hours at a time with no specific reason. This is caused by a build-up of trapped wind in a baby’s bowel, which causes pain and discomfort. Here’s how to avoid it:
- Sit your baby upright during feeding to prevent them from swallowing air.
- Always burp your baby after a feed.
- Your doctor may suggest changing your baby’s formula to a hypoallergenic formula for one week in case your baby is sensitive to lactose or cow’s milk protein. If your baby’s symptoms persist you can go back to your usual formula.
- If you’re breastfeeding, try cutting out caffeinated drinks or cows’ milk and dairy foods for a week to see whether your baby’s symptoms get better.
- If you’re bottle-feeding, change the size of the hole in the teat. A small teat can cause your baby to swallow air. The best way to treat colic symptoms is to add lactase drops to milk during feeds. Simeticone drops also help to release bubbles of trapped air in your baby’s digestive system.
Q: What are the differences between the various types of formula?
A: There are three different types of formula: cow’s milk-based formula, hydrolysed protein formula and soyabased formula.
Most baby formula milks are based on cow's milk, which is modified to resemble breast milk as closely as possible. Manufacturers modify cow's milk for babies by adjusting carbohydrate, protein, and fat levels and adding vitamins and minerals.
Hydrolysed-protein formula is designed for babies with an allergy or intolerance to cow's milk, and have the same nutritional value as standard formula.
Soya-based formula is made from soya beans and modified with vitamins, minerals and nutrients. Only give your baby soya-based formula on the advice of your doctor.
Q: How can you tell if a baby is lactose intolerant?
A: Lactose intolerance means your body can't produce enough lactase, the enzyme needed to digest lactose (the primary sugar in cow's milk and other dairy products). As a result, the undigested lactose stays in the intestine and causes gastrointestinal problems.
The most commons signs that a baby is lactose intolerant include abdominal cramping, bloating, gas and diarrhoea for about 30 minutes to two hours after a feed. Try different bottles until you are sure the problem is not bottle related. Also try a different formula.
Q: What should you do if your baby is still hungry after a feed?
A: As your baby grows, so will their appetite – which can make it difficult to keep up a feeding routine for any length of time. If your baby’s still hungry after a feed, simply increase the frequency or amount you feed them. An increased appetite is one of the first signs a baby is ready to wean. However weaning is not recommended until around six months, and not before 17 weeks, because up until then, your baby's digestive system is too immature for anything more than breast milk or infant formula.
Q: What is the difference between formula and cow’s milk?
A: Formulas provide all the nutrients that most infants need whereas cow’s milk doesn't contain the same nutrients in a healthy balance for an infant. Cow's milk is not appropriate for children under one year of age as it is a poor source of iron, and iron deficiency anaemia is the most common nutritional problem in infants. Additionally, cow's milk is low in vitamin C, vitamin E and copper.
Cow's milk that has not been specially heat processed can also cause intestinal blood loss in some babies. Also, the levels of protein and sodium in cow's milk are higher than recommended for infants, and it contains butterfat, which is difficult for a baby to digest. For these reasons it is recommended that breastfeeding or iron-fortified infant formula be continued during the first year of life.
Q: What should you do when a baby can't keep all his or her milk down?
A: Babies normally posset up their feeds, where a tiny amount of milk will be brought up from time to time, usually after a feed or while being winded. This is completely normal.
A fit of coughing, excessive crying and eating too much may also cause babies to bring up feed, as can indigestion, so try not to rush your baby’s feeds. Occasionally babies have an allergy to the proteins in their mother’s breast milk and this may cause them to vomit. Consult your doctor if you suspect this is the case - you may be advised to change your diet or give your baby a hypoallergenic formula for a while.
Q: Which type of milk is best for which age?
A: First-stage formulas consist of mostly whey protein. These are suitable for your baby from birth up to about a year, and are thought to be easier to digest. Second-stage formulas consist of mostly casein protein. These take longer to digest and are often promoted for hungrier babies. If your baby doesn’t seem content with their first formula, talk to your health visitor before changing to another type.
When your baby’s a year old, they can move from first or second-stage formula to cow's milk.
Q: Are there different types of feeding bottles and teats?
A:There are three types of teats: latex, silicone, and rubber. Latex teats are softer and more flexible, but they don't last as long. Silicone teats are firmer and hold their shape longer. There are also three shapes too – traditional, orthodontic, or flat-topped teats. Teats are also available in a range of sizes and flow speeds. Try a few to find one that works best.
If you're bottle-feeding a newborn, buy the smallest size in a variety of types, and let your baby determine which teat works best.
There are many types of bottles including right-angled bottles that let less air into the teat, streamlined bottles that your baby can hold himself, and disposable bottles. You also can choose between plastic and glass – plastic bottles are unbreakable but they do deteriorate, while glass bottles may do a better job of retaining the nutrients in formula.
Q: What is the best time to start a baby on solids?
A: The best time is round the age of six months, as it’s when babies’ natural stores of iron begin to deplete. A common first baby food is a singlegrain, iron-fortified cereal. These have the advantage of boosting your baby’s iron intake, and they’re easy to digest. Just mix with a little baby formula, breast milk, or even water on occasion. In addition to baby cereal, you can start your baby on pureed fruits and vegetables.
Offer the first solids when your baby isn’t full. Fill your baby up a little with liquid and then let them have a taste. As with all new experiences, it’s best not to spring solid foods on a baby while they’re tired, cranky, or sick.
Offering a new food in the morning or early afternoon also gives you time to watch for allergic reactions. If your baby rejects the new food, don’t worry – just try again later or in a few days.
