108 - Feeding and Teeth

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 ot...