108 - Feeding and Teeth

05/04/22 • 38 min

2 Listeners

Some newborns will eat eight to twelve times a day. In this episode, Dr. Carole Keim MD talks about breastfeeding, formula feeding, pacifiers/nipple confusion, and teething/oral hygiene (also thrush). For the first couple of months, your baby should be eating at least once every 4 hours for development. Pumping can be done right after your baby is born and sometimes even before. Are you looking at formula options? She goes over different types and how to choose what’s best for your little one.

Dr. Carole Keim MD goes over the benefits of breastfeeding for both mom and baby. Eventually, your baby will start to show interest in food, so it is essential to know how to introduce solid foods and approach the risk of allergic reactions. Your baby may start teething at around six months; she talks about signs to recognize, ways to help your baby during this time, and oral hygiene practices.

The next few episodes will be a deep dive into certain topics that I get asked about a lot; these are also laid out just like this in my book, The Baby Manual, available on Amazon/Kindle

feeding, teething - 5/4
pee/poop, gas/colic - 5/18
skin - 6/1
sleep - 6/15
illness/red flags - 6/29
vaccines 0-6mo - 7/13

How often to feed: (0:54)

Newborns eat 8-12x per day, need frequent feeds because their stomach is so small
- Birth - stomach size of a cherry (5-10ml, or 1-1.5 tsp) - colostrum
- Day 2 - walnut (20-30 ml, or 0.75-1 oz)
- 1 week - golf ball (45-60ml, or 1.5-2oz)
- 1 month - (80-150ml, or 2.5-5 oz)
The stomach stretches like a balloon
Overfeeding -> spit ups
- The lower esophageal sphincter develops by 6-12mos of age
8-12 feeds aren’t exactly every 2-3 hours
- Cluster feeding 2-6 am because prolactin is highest
- This typically lasts about 2 weeks, then they learn the night/day difference
- If they sleep 4 hours you MUST wake them
- Newborn - 2 weeks: may eat more than 12x per day
- 2weeks - 2 mos: typically eat every 2-3h
- 2-6 mos: can sometimes go more than 4h between feeds if they are gaining weight and your doctor ok’s it

What to feed them: (4:00)

Breastmilk or formula ONLY for 4-6 mos
- Contains all the protein, fat, carbs, vitamins, minerals, and water your baby needs
At 4-6 mos can start to introduce foods: will come back to this in a bit

Breastfeeding: (4:29)

AAP recommends exclusive breastfeeding x 6 mos, then BFing + food/water until age 1 year or later
Ok to breastfeed as long as you want
Eat a wide variety of foods
Vitamins:
A prenatal vitamin that contains iron and folic acid
Omega-3 fatty acids (200-300mg per day)
Calcium (1000mg per day)
Vitamin D (5,000-6,400 IU per day)
Ok to drink alcohol because of first-pass metabolism: an 8oz drink of 10% alcohol becomes 0.04% BAC (and 0.04% breast milk concentration - 250x less concentrated). 0.08% consumed by baby makes their BAC 0.0001% (undetectable; less than BAC after a child drinks orange juice or eats an over-ripe strawberry)
- When inside, your BAC = baby’s BAC
Each time baby eats, they are placing an order for the next feed
- First 3-5 days colostrum; need to nurse for 15-20 min per side per feed to stimulate milk production

Benefits of Breastfeeding: (9:53)

Emotional: releases oxytocin, a bonding hormone, and endorphins
Health: decreases postpartum bleeding, decreased risk of breast cancer and ovarian cancer, decreased risk of rheumatoid arthritis, decreased risk of postpartum depression, can help you lose baby weight because burns an additional 500 cal per day
Baby benefits: decreased risk of obesity and type 2 diabetes as adults, less chance of infection due to IgA, decreased risk of SIDS, less likely to develop atopic and autoimmune diseases
Extra benefits nobody really talks about: poop won’t smell bad and is water-soluble, you always have it on hand, the composition changes as your baby grows, it’s free

Tricky things about breastfeeding: (12:40)

Takes babies up to 2 weeks to get a hang of it
Can be painful for the first 2 weeks
- Aggressively moisturize your nipples
Tongue-tie: only class 4 needs repair. Lip and cheek ties do NOT need to be repaired.

Pumping: (14:37)

Can start as soon as the baby is born; pumping while pregnant can induce labor
Choosing a pump: manual vs. electric, how much suction, how portable, single or double
Getting the best return:
- Early morning (prolactin peak)
- One side while baby latches on the other...

The next few episodes will be a deep dive into certain topics that I get asked about a lot; these are also laid out just like this in my book, The Baby Manual, available on Amazon/Kindle

feeding, teething - 5/4
pee/poop, gas/colic - 5/18
skin - 6/1
sleep - 6/15
illness/red flags - 6/29
vaccines 0-6mo - 7/13

How often to feed: (0:54)

Newborns eat 8-12x per day, need frequent feeds because their stomach is so small
- Birth - stomach size of a cherry (5-10ml, or 1-1.5 tsp) - colostrum
- Day 2 - walnut (20-30 ml, or 0.75-1 oz)
- 1 week - golf ball (45-60ml, or 1.5-2oz)
- 1 month - (80-150ml, or 2.5-5 oz)
The stomach stretches like a balloon
Overfeeding -> spit ups
- The lower esophageal sphincter develops by 6-12mos of age
8-12 feeds aren’t exactly every 2-3 hours
- Cluster feeding 2-6 am because prolactin is highest
- This typically lasts about 2 weeks, then they learn the night/day difference
- If they sleep 4 hours you MUST wake them
- Newborn - 2 weeks: may eat more than 12x per day
- 2weeks - 2 mos: typically eat every 2-3h
- 2-6 mos: can sometimes go more than 4h between feeds if they are gaining weight and your doctor ok’s it

What to feed them: (4:00)

Breastmilk or formula ONLY for 4-6 mos
- Contains all the protein, fat, carbs, vitamins, minerals, and water your baby needs
At 4-6 mos can start to introduce foods: will come back to this in a bit

Breastfeeding: (4:29)

AAP recommends exclusive breastfeeding x 6 mos, then BFing + food/water until age 1 year or later
Ok to breastfeed as long as you want
Eat a wide variety of foods
Vitamins:
A prenatal vitamin that contains iron and folic acid
Omega-3 fatty acids (200-300mg per day)
Calcium (1000mg per day)
Vitamin D (5,000-6,400 IU per day)
Ok to drink alcohol because of first-pass metabolism: an 8oz drink of 10% alcohol becomes 0.04% BAC (and 0.04% breast milk concentration - 250x less concentrated). 0.08% consumed by baby makes their BAC 0.0001% (undetectable; less than BAC after a child drinks orange juice or eats an over-ripe strawberry)
- When inside, your BAC = baby’s BAC
Each time baby eats, they are placing an order for the next feed
- First 3-5 days colostrum; need to nurse for 15-20 min per side per feed to stimulate milk production

Benefits of Breastfeeding: (9:53)

Emotional: releases oxytocin, a bonding hormone, and endorphins
Health: decreases postpartum bleeding, decreased risk of breast cancer and ovarian cancer, decreased risk of rheumatoid arthritis, decreased risk of postpartum depression, can help you lose baby weight because burns an additional 500 cal per day
Baby benefits: decreased risk of obesity and type 2 diabetes as adults, less chance of infection due to IgA, decreased risk of SIDS, less likely to develop atopic and autoimmune diseases
Extra benefits nobody really talks about: poop won’t smell bad and is water-soluble, you always have it on hand, the composition changes as your baby grows, it’s free

Tricky things about breastfeeding: (12:40)

Takes babies up to 2 weeks to get a hang of it
Can be painful for the first 2 weeks
- Aggressively moisturize your nipples
Tongue-tie: only class 4 needs repair. Lip and cheek ties do NOT need to be repaired.

Pumping: (14:37)

Can start as soon as the baby is born; pumping while pregnant can induce labor
Choosing a pump: manual vs. electric, how much suction, how portable, single or double
Getting the best return:
- Early morning (prolactin peak)
- One side while baby latches on the other...

Previous Episode

107 - 6 Months Old

Did you know you can potty train your six months old infant? Dr. Carole Keim MD talks about potty training, babyproofing, routines, and stranger anxiety. Your six-month-old should be recognizing familiar faces and reacting to their own name. Now is also a good time to use your support network to help with tasks, get a babysitter and go on a date. It is ok to leave your infant for a few hours and ask for help when overwhelmed.

Dr. Carole Keim MD goes into great detail about the power of routines. Routines for feeding, winding down, sleeping, and leaving the house. Your infant will start to recognize these patterns and know what you are doing. Check out this episode for more information about your six-month-old infant.

Parents: (00:43)

For many this is a “golden” age - you’ve got a good handle on things, sleeping fairly well, have routines down, parents show confidence with infant (it’s ok if you’re not! But also keep postpartum depression in mind.)
Establish routines
Interact with baby, respond to cues
Talk/sing, read, play peek a boo
Use support networks, balance parent roles/responsibilities
Date night with trusted babysitter

Development: (02:25)

Socially interactive
Happy feet
Recognizes familiar faces
Babbles
Takes turns babbling / making sounds like squeals, blowing raspberries, rrr
Starts to know own name
Visual and oral exploration to learn about environment
Rolls over both ways
Tripod sit / sit with support (baby seat, high chair)
Stands and bounces (johnny jump up / activity center)
“Swims” on land (pre-crawling)
Turns while sitting to look at things
Raking grasp
Can bring hands together, transfer hand to hand, and put objects in mouth
No object permanence yet
Toys: soft toys, crinkly toys, rubber/silicone toys, rattles no hard eyes/noses, no small parts (choking hazard)

Sleep: (09:14)

Safe sleep: alone, on their back, in a crib.
Crib should be in parents’ room until 1 year of age
Lower crib mattress (pull to stand)
No blankets until 1 year, no pillows til age 2 - very high risk at this age - rolling
Maintain a bedtime routine; feed, brush teeth/gums with water, read, sing, set down awake but drowsy
Things that can help, but only if they need it: blackout blinds, white noise machine, music

Nutrition: (11:48)

Primarily breastmilk or formula; starting solids
How to start solids:
- Baby-led weaning vs. purees (traditional)
- rice/oat cereal optional (pros/cons)
- progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
- one new food every 3-4 days
- signs of food allergy: rash, vomiting
give water (ounce per ounce with foods)
Start consolidating meal times
Consider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby food
Expect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cues
Gagging is normal, choking is not

Teeth: (19:30)

Teeth can appear anytime; brush 2x per day with water and soft toothbrush
Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel
Fluoride: check if it’s in tap water, if not, can consider using fluoride toothpaste (grain of rice sized amount)
Avoid laying them down with a bottle, never prop a bottle

Peeing/pooping: (24:49)

Peeing about 4-6x per 24h
Poop is now more solid because they are eating foods; can consider starting potty training now

Skin: (26:40)

Bathing 2-4x per week; wipe skin folds a few times per day
Can use lotion or cream or ointment after baths - watch those folds for rashes though
Sunscreen, insect repellant: any baby sunscreen is ok, citronella works for insects and is safe
Diaper rash and drool/food/skin fold rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
- Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
Cradle cap - olive oil / vaseline / aquaphor at night, soft baby brush in the morning

The 6 month checkup: (30:23)

Baby should have gain...

Next Episode

109 - Tummy Troubles

Does your baby show signs of discomfort after feeding? In this episode, Dr. Carole Keim MD goes over practices to best help your baby through peeing/pooping, gas, colic, and other tummy troubles. If your baby has colic, there are ways to help digestion and alleviate discomfort. Vomiting in infants can be a bad sign; she explains how best to keep your little one hydrated with no treatment for vomiting or diarrhea.

Dr. Carole Kiem MD details different conditions your baby may experience within their first year, such as diarrhea, constipation, vomiting, and reflux. Watch out for blood in the diaper; she goes over the potential causes, from stool to urine or even a “false period” in baby girls. Check out this episode for more information about tummy troubles.

We will cover:

Pee
Poop
Potty training an infant
Burping
Gas
Colic - dx and tx
Spit ups / GERD
Vomiting - gastroenteritis, pyloric stenosis, no tx
Diarrhea - tx, when to be concerned, signs of dehydration
Constipation
Blood in the diaper

Pee (0:21)

Allow up to 24h for the first void.
A few pees for the first few days; by day 3-5, mom’s milk surges, and baby voids with each feed
Volume is difficult to discern, and the color is sometimes pale - diapers with urine stripes are helpful.
Rust-colored urine in the first 2-3 days (uric acid crystals)
If a baby less than six mos voids less than 6x per 24h or goes more than four h between voids, they may be dehydrated (nighttime doesn’t count!). Babies >6 mos should void at least once per 6h.

Poop (2:48)

Up to 48h for first stool
Meconium (and what it means if passed in utero)
Transitional stools
Yellow seedy stools
Over the first 4-6 months becomes brown and toothpaste-consistency
Formula-fed babies may have brown, yellow, or green stool; tends to be smellier
Hydrolyzed formula -> gray stools
Rule of 7’s
Once they eat food, their poop becomes like adult poop

Potty training from birth / Elimination communication / Diaper-free method (6:27)

Involves reading baby’s cues and giving cues when it’s time to potty
Can start as early as birth; I recommend around 1-2mos of age after the discoordinate stooling phase.
Decide on a phrase and/or hand signal to use
Bring your baby to the potty (over the sink, potty chair, or toilet adapter)
Make a sound to indicate it’s time to go (“psss” or grunt)
Easy catches: babies who go during diaper changes, right after waking up, after eating, when you see them pooping
It takes several months; ok to wait until later. Toddlers: takes about 6 mos for daytime and another 6-12mos for nighttime.
I love it because there are fewer diapers, less discomfort for the baby, less diaper rash, and it is easier than toddlerhood.

Burping (12:28)

How to
When to (breastfed, formula-fed)
Why? Decreases gas, colic, spit-ups
They can stop when they burp on their own (around 4-6 mos)

Gas (14:20)

Normal to fart a lot, loudly, and have smelly gas
Breastfed babies may get more gas when mom eats cruciferous vegetables, beans, garlic, and caffeine
Check with your doctor before you start eliminating foods
Simethicone - how it works, when to give it, how often

Colic (16:21)

Rule of 3s: 3h per day, 3 days per week, for 3 weeks
Almost all babies get some colic symptoms at some point.
Tummy Time
Bicycle legs
Belly massage - clockwise
Back rubs - counterclockwise
Medicines: simethicone, probiotics, gripe water; can consider chamomile, licorice, or mint tea - dilute, 1/2oz per day
Alternative health: chiropractic, acupuncture, ayurveda - I can’t formally recommend them, but they are sometimes helpful; choose your practitioner carefully.
What doesn’t work - is the sensitive tummy formula. No formula will treat colic.

Spit ups / GERD (20:47)

Reflux = stomach contents go up into the esophagus.
GERD = reflux is so bad that the baby has poor weight gain or loses weight, chokes, arches in pain, or has other problems
LES
Spit-ups are not forceful.
Tx: decrease volume and increase the frequency of feeds (BF vs. formula), burp baby well, anti-reflux formula/breast milk thickeners, add 1 tsp rice cereal to 2oz formula/breastmilk (this is the ONLY time we put rice cereal in a bottle), use gravity, medications such as ranitidine make the stomach produce less acid but don’t decrease the volume
Call your doctor if the baby spits up more...