Patient information: Breastfeeding

1) Breastfeeding

Do doctors recommend breastfeeding for most babies? — Yes. Doctors recommend that, when possible, women feed their babies only breast milk until the baby is 6 months old. Breast milk has all of the nutrition that babies need until they are 6 months old. Breastfeeding can also help prevent babies from getting ear infections, lung infections, or diarrhea.
When can I start breastfeeding? — Most women can start breastfeeding within a few hours after giving birth. For the first few days, most women make only a small amount of yellowish milk called “colostrum.” Colostrum has all of the nutrition a newborn needs. Most women start making more milk after 2 or 3 days.
How should I hold my baby during breastfeeding? — There are different ways you can hold your baby during breastfeeding (figure 1). You can try different positions to figure out which way works best for you and your baby.
What does “latch-on” mean? — Latch-on is another word for when a baby makes a tight seal with his or her mouth around the nipple and the areola (the dark skin around the nipple) (figure 2). A good latch-on helps the baby get enough milk and can prevent the mother’s nipples from getting hurt. But even with a good latch-on, it can be normal for women to feel a little pain when a feeding starts.
How often should I breastfeed and how long should a feeding last? — A woman should breastfeed when her baby shows signs of being hungry. A baby can show that he or she is hungry by:
  • Waking up from sleep
  • Moving the head around as if he or she is looking for the breast
  • Sucking on his or her hands, lips, or tongue
Babies can breastfeed on different schedules and for different amounts of time. For example, some babies finish a feeding in 5 minutes, but others might take 20 minutes or longer.
Doctors recommend that women finish breastfeeding on one side so that a baby gets all the milk from that breast. Then, a woman can see if her baby wants to drink from the other breast.
How do I know if my baby is getting enough breast milk? — You can tell if your baby is getting enough breast milk by:
  • Checking his or her diapers – By day 4 or 5 after birth, babies should have at least 6 wet diapers a day.
  • Checking his or her bowel movements – By day 4 after birth, babies should have 4 or more bowel movements a day. By day 5, their bowel movements should be yellow.
  • Having your doctor or nurse check to see if your baby is gaining weight
Does my baby need any other food or drink? — For the first 6 months, most babies need only breast milk. But your doctor might recommend that your baby take a liquid vitamin, too.
When a baby is 6 months old, he or she can start eating and drinking other foods. Ask your doctor or nurse which foods you can feed your baby and when.
What problems can happen during breastfeeding? — Some women have problems during breastfeeding that can include:
  • Swollen, hard, and painful breasts
  • Painful or cracked nipples
  • Breast or nipple infections
  • Blocked milk ducts, which can cause red and painful breast lumps
How are breastfeeding problems treated? — Breastfeeding problems are treated in different ways. Treatment will depend on the problem. For example, women with swollen, hard, and painful breasts often feel better if they:
  • Use their hand or a breast pump to let some milk out.
  • Use an ice pack or take pain-relieving medicine to treat the pain
  • Take a warm shower to start their milk flow and let some milk out
Talk with your doctor or nurse if you are having problems with breastfeeding. Most breastfeeding problems can be treated. Some women also find it helpful to talk with a breastfeeding expert called a “lactation consultant.”
Should I see a doctor or nurse? — Call your doctor or nurse if you have:
  • A blocked milk duct that does not get better
  • A fever and a hard, red, and swollen area of the breast
  • Blood leaking from the nipples
  • Pain that lasts for the whole breastfeeding session
Do I need to eat or drink more when I am breastfeeding? — Yes. Women need to eat extra calories and make sure that they drink enough fluids. Ask your doctor if there are vitamins you should take, or foods or medicines you should avoid.
When should I stop breastfeeding? — Women choose to stop breastfeeding at different times and for different reasons. But doctors do not recommend that women stop breastfeeding all at once. Instead, when you decide to stop breastfeeding, you can drop one feeding every 2 to 5 days, or breastfeed for fewer minutes each feeding.

Patient information: My Child is Overweight

2) My Child is Overweight

How do I know if my child is overweight? — Your child’s doctor or nurse will tell you. He or she will measure your child’s height and weight and use those measurements to calculate a number called the “body mass index” or “BMI.”
The doctor or nurse will use your child’s BMI to tell if your child’s weight is healthy for his or her height. To do this, the doctor or nurse will compare your child’s BMI to the BMIs of other children of the same age and sex. If your child’s BMI is high compared to other children, he or she is overweight. When a child’s BMI is much too high, doctors sometimes use the terms “obese” or “obesity.”
Why is it important for my child to have a healthy weight? — It’s important to have a healthy weight, because children who are very overweight can have:
  • Liver problems
  • Asthma – This is a lung condition that can make it hard to breathe.
  • High blood pressure
  • Knee or back pain
  • Sleep apnea – This is a condition that makes people stop breathing for short periods during sleep.
It’s also important that your child have a healthy weight so that he or she will have a healthy weight as an adult. Being overweight as an adult can lead to medical problems such as high blood pressure, diabetes (high blood sugar), heart attacks, and some types of cancer.
What causes children to be overweight? — Children can be overweight for different reasons. Some children simply gain weight more easily than other children. These children can become overweight by eating too much, eating unhealthy foods, or not getting enough exercise. When children gain weight very easily, they have to work extra hard to get to and stay at a healthy weight.
Although uncommon, some medicines and medical conditions can also make children gain weight more easily.
Will my child need tests if he or she is overweight? — Maybe. The doctor or nurse will talk with you and your child, and do an exam. He or she might do blood tests to check for:
  • A condition that could be causing your child to gain weight easily
  • Health problems that can happen when children are overweight
How can I help my child get to a healthy weight? — To help your child get to a healthy weight, you need to help him or her eat healthy foods and be more active. Making these lifestyle changes can be hard, especially at first.
To help you and your child start making lifestyle changes, think of the numbers 5-2-1-0. Each of these numbers stands for a goal you can try to reach every day to help your child be healthier.
  • 5 – Have your child eat 5 servings of fruits or vegetables each day. Frozen fruits and vegetables count towards the goal, but fruit juice does not. A serving is usually 1 whole fruit (such as an apple or banana) or ½ cup of vegetables. If your child does not like vegetables or fruit, start slowly. Eat these foods yourself to set a good example, and have your child keep trying them.
  • 2 – Limit your child’s “screen time” to 2 hours or less each day. Screen time includes watching TV, playing video games, or using the computer for things other than homework.
  • 1 – Have your child do physical activity for 1 hour or more each day. This can include doing a sport, dancing, or playing outside.
  • 0 – Your child should have 0 sugary drinks each day. Sugary drinks include soda, sports drinks, and all juices.
You and your child might not be able to meet all of these goals at first, but that’s OK. Choose 1 or 2 goals to try first. Later on, you can try to meet all of these goals.
Is there anything else I can do to help my child? — Yes. You can:
  • Avoid bringing unhealthy food into your home. If you have unhealthy food in the home, your child is likely to eat it even if you tell him or her not to.
  • Involve the whole family. Have everyone in the family eat healthier and be more active, even those who have a normal weight. Try to do physical activities as a family. This can be as simple as going to a playground or taking a walk.
  • Tell your child that the goal is for him or her to be healthy and strong. Let him or her know that the way to be healthy and strong is to eat healthy food and be active.
  • Get help if being overweight is causing your child to be sad, worried, or have a hard time in school. Ask the doctor or nurse for ways to get help for your child.
  • Work with your child’s doctor or nurse. See him or her for regular check-ups, so that he or she can follow your child’s BMI over time. Let the doctor or nurse know if you are having trouble meeting the 5-2-1-0 goals. He or she can help you get started or give you some tips. He or she might also recommend that you talk with a dietitian (food expert). A dietitian can help you choose healthy foods and plan meals.

Patient information: Vitamin D for Babies and Children

3) Vitamin D for Babies and Children

Why is vitamin D important for babies and children? — Babies and children need vitamin D to grow normally and develop healthy bones.
What can happen if babies and children don’t get enough vitamin D? — Babies and children who don’t get enough vitamin D can get a condition called “rickets.” Rickets can make bones thin and weak. Some children with rickets have legs that bend to the side, called “bow-legs”
Is my baby or child at risk of getting too little vitamin D? — Maybe. If your baby only gets breast milk, or breast milk and some formula, he or she needs extra vitamin D. Breast milk has most of the nutrients a baby needs, but it does not have enough vitamin D in it.
Babies and children can also be at risk if they:
  • Have dark skin
  • Do not drink enough milk or eat other foods with vitamin D in them
  • Take certain medicines
  • Were born premature
  • Have a medical condition that makes it hard to get enough vitamin D, such as cystic fibrosis or celiac disease
  • Spend most of their time inside or live in a place with little sun
How can I make sure my baby or child gets enough vitamin D? — Vitamin D supplements are the best way to make sure your baby or child gets enough vitamin D for healthy bones. Supplements are pills, capsules, or liquids that have nutrients in them.
How much vitamin D does my baby or child need? — Experts recommend that all babies and children take 400 to 600 international units of vitamin D a day starting a few days after birth. If your child has a condition that makes it hard to get enough vitamin D, he or she might need to take more.
Talk to your child’s doctor or nurse about which type of vitamin D to give your baby or child, how much, and when to give the supplements. The right dose will depend on your child’s diet, whether he or she has any medical conditions, and other factors.
It is important not to give your child too much vitamin D. Giving too much vitamin D can make your child sick.
Is there a test for vitamin D? — Yes. Your child’s doctor or nurse can do a blood test to check your child’s vitamin D levels.
Can my baby or child get vitamin D from foods and drinks? — Yes. Foods and drinks that have a lot of vitamin D include
  • Baby formula, milk, orange juice, or yogurt with vitamin D added
  • Cooked salmon or mackerel
  • Canned tuna fish
  • Cereals with vitamin D added
  • Cod liver oil

Your baby or child can also get vitamin D from the sun. The body uses sunlight that shines on the skin to make vitamin D. Playing outside can help your child exercise and get vitamin D at the same time. But it is important to ask your child’s doctor or nurse how much sun is enough. Your child should wear sunscreen at least part of the time to prevent sunburn and other conditions caused by too much sun

Poor Weight Gain in Babies and Children

4) Poor Weight Gain in Babies and Children

How do I know if my baby is not gaining enough weight? — Your doctor or nurse will tell you if your baby is not gaining enough weight. At each visit, he or she will weigh your baby. Then he or she will compare your baby’s weight to the weight of other babies who are the same age and sex. Babies who weigh less than other babies of the same age and sex are not gaining enough weight.
Some babies do not gain enough weight starting at birth. Other babies gain enough weight for a while, but then slow down or stop gaining weight.
If your baby isn’t gaining enough weight, your doctor or nurse will want to figure out why. He or she will treat the cause and work with you to help your baby gain more weight. Babies need to gain enough weight so that they can grow and develop normally. Babies who do not gain enough weight can have problems later in life, such as learning problems or problems with the body’s infection-fighting system.
What are reasons that a baby might not gain enough weight? — Reasons that a baby might not gain enough weight can include:
  • Being born too early
  • Not getting enough food – For example, some babies have trouble sucking at the breast or bottle. Or parents might not feed their baby often enough.
  • Having a medical problem that affects the stomach, mouth, throat, or heart
  • Changes or stress in the home or family
  • Having things around that take attention away from eating
How can my doctor figure out why my child isn’t gaining weight? — Your doctor or nurse will do an exam and ask you questions about your child’s eating habits. He or she might ask you to keep track of all the food that your child eats . Let your doctor or nurse know if your child:
  • Has vomiting or diarrhea
  • Does not eat certain foods
  • Drinks much more than he or she eats
Your doctor might also order a test.
Who do I work with to help my child gain weight? — Your doctor or nurse will work with you to make a plan to help your child to gain weight. He or she might recommend that you also work with other experts, such as a dietitian. A dietitian is an expert on food and eating.
Most children can be treated at home. But some children need to stay in the hospital for a short time. In the hospital, doctors can treat children and watch them closely.
What can I do to help my child gain enough weight? — You can do different things to help your child gain enough weight . You can change:
  • What your child eats – You can help your child gain weight by feeding him or her foods with a lot of calories. Talk with your doctor, nurse, or dietitian about the right way to do this. He or she might recommend that you add extra calories to your baby’s feedings. Or you might need to add cheese, butter, or sour cream to foods that your older child eats. Your doctor or nurse might also recommend that your child take a vitamin every day.
  • How often your child eats – Babies might need more feedings each day to gain weight. Older children might need to eat every 2 to 3 hours, and have 3 meals and 3 snacks a day.
  • Where and how your child eats – Making changes to the area where your child eats might help your child eat more. For example, some children eat more when the whole family eats together or when meals are fun.
What other treatments might help my child gain enough weight? — Sometimes, other types of treatments can help. These can include:
  • Medical treatments – Some children need to be treated for medical problems that can keep them from gaining enough weight.
  • Physical or occupational therapy – Some children have problems with their body or behavior that can make it hard for them to eat enough food. People called “physical therapists” or “occupational therapists” can work with children to improve these types of problems.
  • Family help – Some children do not eat enough because of problems at home. A family might not have enough food, or a parent might be too sick to take care of a child. Your doctor or nurse can work with you to find programs or people who can help with these types of problems.

When do I follow up with my doctor or nurse? — Your doctor or nurse will follow-up with you on a regular basis. On each visit, he or she will weigh your baby and talk with you. Let your doctor or nurse know if you are having any problems with treatment