TIJANA VRANEŠ
Table of Contents PREFACE.....................................................................................................7
PART I – NUTRITION WHY BABY’S NUTRITION CAUSES STRESS..........................................11 BREASTFEEDING.....................................................................................14 Why Breastfeeding is the Best Choice for You and Your Baby... 15 Preparation for Breastfeeding......................................................... 17 Helpers................................................................................................ 17 Basic Facts about Breastfeeding.................................................... 20 Correct Breastfeeding....................................................... 20 First Time Breastfeeding....................................................21 Milk Production.......................................................................... 24 Milk Composition....................................................................... 26 What to Do When Breastfeeding Simply Is Not Working............27 “Natural Feeding” ............................................................ 29 Breastfeeding at Request—For and Against........................ 30 INTRODUCING SOLID FOODS .............................................................35 General Indicators of Baby’s Readiness to Start Consuming Solid Foods................................................................... 36 Fifth Month........................................................................................ 36 The Best and the Safest Food in This Period ..................... 36 Ways to Introduce New Foods........................................... 39 What Baby is Allowed and Should Drink ..........................40 Things to Pay Attention to in This Period .........................40 Equipment Required for Feeding the Baby..............................41 Sixth Month........................................................................................41 Seventh Month.................................................................................. 43 Eighth Month.................................................................................... 44 Ninth Month...................................................................................... 46 Tenth Month.......................................................................................47 From Eleventh through Thirteenth Month................................... 48 If You Are Starting With Solid Foods Later................................... 49 NUTRITION OF CHILDREN WITH ALLERGIES AND ECZEMA........... 51 How to Distinguish Allergy from Intolerance................................52 What to Do While Waiting for Your Child’s Allergy to Withdraw..................................................................................53 Beverages That Replace Milk and Dairy Products....................... 54 Allergies and Eczema .......................................................................55
PART II – HEALTHY EMOTIONAL DEVELOPMENT WAYS FOR YOU AND YOUR BABY TO AVOID SHEDDING UNNECESSARY TEARS ......................................................................... 58 WHAT IS TROUBLING YOUR BABY......................................................60 Why Babies Cry.................................................................................60 Need for Physical Contact............................................................... 65 Need for Sleep .................................................................................. 69 Putting Babies to Sleep......................................................71 Waking Up at Night.......................................................... 72 Sleeping in Parents’ Bed .................................................. 74 Sleeping in Quiet Surroundings........................................ 77 Need for Predictable Daily Routines..............................................78 Need for Stimulation........................................................................80 WHAT IS TROUBLING BABY’S PARENTS............................................ 85 Baby Coming Home ......................................................................... 85 Relationship between Partners after Baby is Born...................... 86 Marriage Crisis after the Birth of Child............................. 87 Woman Facing Challenges of Maternity........................... 88 Man’s “Expulsion from the Garden of Eden”......................89 Can These Problems Be Avoided?......................................90 Father’s Role in the First Year ........................................................ 93 Older Child’s Jealousy...................................................................... 97 Parents’ Fears...................................................................................103
PART III – PLAY ABOUT PLAY........................................................................................... 112 DEVELOPMENT AND PLAY IN FIRST TRIMESTER........................... 115 Stimulation of Development through Play in First Trimester... 116 Toys in First Trimester .................................................... 119 DEVELOPMENT AND PLAY IN SECOND TRIMESTER..................... 120 Stimulation of Development through Play in Second Trimester... 121 Toys in Second Trimester................................................. 123 DEVELOPMENT AND PLAY IN THIRD TRIMESTER .........................124 Stimulation of Development through Play in Third Trimester...126 Toys in Third Trimester....................................................128 DEVELOPMENT AND PLAY IN FOURTH TRIMESTER.......................130 Stimulation of Development through Play in Fourth Trimester.. 132 Toys in Fourth Trimester.................................................. 135 CLOSING WORD....................................................................................136
WHY BABY’S NUTRITION CAUSES STRESS
My older son Vasa was eight days old when a first floor neighbor rang at our door, holding a few folded, handwritten papers in her hand; she gave them to me as if she was handing over the Olympic Torch. She said that those were the notes that she took while a community nurse explained to her how to introduce solid foods into her son’s nutrition, and that she was giving them to me now since she had benefited a great deal from the advice and that she had done a great job following them. That day I could not understand the importance of what she was saying. I was excited and exhausted. I stared at the papers in a rather distracted manner and, after trying to understand the elaborate timetable suggested by an unknown community nurse, I decided to postpone thinking about solid foods. Even before giving birth I’d had a plan to breastfeed, and knowing that UNICEF strictly recommends breastfeeding until the sixth month of the child’s life, after which solid foods should be gradually introduced, I thought I had time. It was beyond me why such importance is attached to babies’ nutrition and what it was that made the task end in success or in failure in the first place. Only later, when I started having similar concerns regarding the same issue, could I understand the reasons why my neighbor came to me with the notes. My motivation to write this book was of a similar nature. It was an attempt to tell my story and share the experience of my baby’s first year, which was a year that taught me many things. I learned a lot by trying out many things and making many mistakes that I later corrected. I made decisions and conclusions, and, finally, coped successfully with the stress of the baby’s first year. Of course, it wasn’t as easy as one may believe. UNICEF is not the only one that will give you advice on how to feed your baby; there’s also your mom, mother-in-law, grandmothers, pediatricians, community nurses, Internet sites, friends, other moms from the park, casual passers-by in the street… Obviously, every one of them has their own opinion and takes the liberty to share it with you. Needless to say, those opinions are almost always contradictory.
12
TH E F IR S T Y EAR IN YO U R PO C K ET
My husband and I were quite at a loss about what to do. His side of the family seemed to be obsessed with the idea that the baby was hungry all the time and they recommended that I should breastfeed Vasa as often as I could. The grandmother was the most insistent of them all. Always at my heels, she would repeat in panic: “Suckle him! Suckle him!” My head was already about to explode. My two good friends had babies of the same age but, instead of helping each other we somehow managed to confuse one another even more. To make things worse, even the recommended bibliography sources differ with regards to what is crucial. The advice on the subject is contradictory to a considerable degree, depending on the country in which the book was written and the time when it was published. I asked for advice from a pediatrician, but I soon realized that the pediatrician in the morning shift had a somewhat different opinion than the one in the afternoon shift. The instructions that my friend had received in another community health center were completely different from the ones I got. The most radical was our old family friend, a retired pediatrician, whose ideas contradicted everything that I had ever heard or read about baby nutrition. There was simply no consensus on most of the issues, the toughest ones being on breastfeeding, establishing feeding patterns and introducing solid foods. Some of the most important were: How am I supposed to know if I have enough milk? Is it alright to introduce a diary based infant formula? Should I give him/her water? Is it alright to breastfeed whenever the baby wants or should I establish feeding patterns? When should be the last time the baby is fed at night? Should I wake the baby up or let him/her sleep? How much weight should the baby gain each month and how should I know if he/she is full? When should I start introducing solid foods? What are the best solid foods to start with? It all seems somewhat ridiculous from this point of view, but there were moments when I actually thought that I would never find a right way to deal with things. Later, when everything fell into place and the initial tension about feeding the baby started to wear off, I was able to pay more attention to different approaches that parents have to their child’s nutrition. I came to the conclusion that many problems related to children’s nutrition emanate much more from the parents’ attitude to food than from the child’s behavior. Parents that approach the feeding issue too strictly, with high expectations and lack of patience, will easily create tension during feeding and make the situation unpleasant for the child. A nervous child will most likely refuse to cooperate, which will make the parent more uneasy. Such occurrences create a vicious circle, which may last for years after the child is given solid food for the first time. I have met a seven-year-old girl whose mother still used to feed her every day at lunchtime, as well as a five-year-old boy who ate only strained food. I also know a fouryear-old girl who is slowly becoming obese, while her mother is constantly complaining about how her child does not eat enough and giving her all kinds of snacks all the time, hoping that her daughter would finally put on some weight.
Pa r t I – N UTRITI ON
13
It often happens that feeding becomes the main topic in the family, a reason for argument, bribery, blackmailing, a cause of stress and frustration on both sides. That is why it is important from the very start to be patient and ready to compromise, but also to be principled and consistent in trying to establish a feeding pattern. Believing in what you do is essential. You should make decisions about your baby’s nutrition and not let well-intentioned advice, given by every person that comes your way, change your decisions. There are more opinions on the subject than it is possible to take and process, which means that you simply can’t allow every new information interfere with what you have planned for your baby. It will just cause you insecurity and make you question yourself, and the fact is that baby nutrition, although very important, is not as complex as it may seem at the beginning. Apart from all this, it is very important to approach the issue of feeding in as relaxed manner as possible, since it will also show in your baby’s attitude to food. What you are aiming at is to instill a positive attitude to food in your baby, make the first meals go as smoothly as possible and create a pleasant atmosphere in which your baby will be open for different tastes. I am aware that creating a relaxed feeding atmosphere it is more easily said than done. Still, try not to be nervous if everything does not go according to the plan. Occasional departures from the established feeding pattern are possible and expected. Babies are different in many respects, and it is also the case with their feeding habits. I hope that the guidelines presented in this book will help you create a positive attitude to your baby’s nutrition.
BREASTFEEDING
Mother’s milk is the best baby food. All experts agree on that. Most of mothers are aware of that fact too. However, the research that UNICEF conducted in Serbia in 2010 showed that over 90% of mothers breastfeed their babies upon leaving the hospital, whereas the number drops by two thirds not more than a month after—only 30% of mothers continue to breastfeed. After six months, only 14% of mothers are still breastfeeding. In other words, although almost all mothers successfully breastfeed in the first days of their baby’s life, most of them stop after several weeks or months. Why do some women breastfeed with ease and pleasure from the very start, while others don’t succeed in doing it? The answer lies in the fact that breastfeeding is not only about the maternal instinct. It is a skill and is not something that we are born with. You learn how to breastfeed. The same goes for babies. Although they are born with the sucking reflex and instinctively turn their heads towards their mother’s breast only a few minutes after they are born, they also need help to make breastfeeding successful and last as long as it is necessary. The longer the separation between the mother and the baby is after the birth, the smaller are the chances that the learning process will go s m o o t h l y. S o m e t i m e s t h e doctors decide to keep the baby
Pa r t I – N U TRITI O N
15
in the hospital longer than it is normally the case. Even when it happens for some banal reason such as, for example, extended physiological jaundice, the separation can become a more serious problem, since it slows down the process of establishing a breastfeeding pattern and can lead to giving up on breastfeeding too early. While in hospital, babies are formula fed and they get used to it very quickly, while mothers experience a decrease in milk supply due to the lack of regular milk discharge. When the baby and the mother are finally together again, it is not always easy for either of them to surmount the difficulties that have arisen in the meantime. Not much attention is paid to training women how to breastfeed in the first days after giving birth. What are the reasons for that? There is a number of them—the hospital and community health center staff is not engaged properly in advocating breastfeeding, whereas the wider community is not enough supportive about it. The good thing is that lately more and more organizations have tackled this issue within different projects. This book offers some possible solutions, verified in practice, for the usual problems that women encounter then they start to breastfeed.
Why Breastfeeding is the Best Choice for You and Your Baby Breastfeeding has a positive influence on the health of both the mother and the baby at various levels. It is very important to know that the mother’s milk is the ideally balanced food for every newborn. That means that you should never worry about if your milk is “good enough” or “strong enough”, which is something that the already worried and scared mothers are often told. Rest assured that your milk has the best possible mixture of proteins, fats, carbohydrates, minerals and vitamins. And that is not all. Unlike the infant formula, which is universally composed for every baby, the mother’s milk has the unique quality of being completely adapted to all the needs that your baby has throughout the day. The milk composition changes as the months pass and during that time the mother’s body creates a perfect nutritive combination for her baby. The breastfed babies are less susceptible to various infections since the mother’s milk contains the antibodies that protect the baby from the viruses and bacteria found in baby’s immediate surroundings. When you kiss and sniff your baby, apart from making your baby feel loved and cared for, your lips are also collecting the samples of different microorganism from your baby’s skin. Your body reacts to them by producing adequate antibodies, which you “deliver” to your baby by breastfeeding. Breastfeeding is extremely important and is specially recommended for the children that are genetically prone to certain chronic diseases, as a preventive measure for allergies, eczema and other skin disorders, as well as obesity, diabetes, asthma, etc. The mother’s milk can be of invaluable help to the babies that are in need of special care, such as prematurely born babies or babies with special needs. While in hospital intensive care wards, mothers often pump breast milk and store it safely in sterile cups so that the medical staff can use the milk to feed the babies that are placed in intensive care nurseries, due to which they can’t be properly breastfed. It is thought that the babies that receive this kind of treatment thrive more rapidly and are released home earlier than
16
TH E F IR S T Y EAR IN YO U R PO C K ET
the babies fed infant formula, even when it is the special kind of formula designed for premature babies. In brief, there is not a way to artificially create milk that could compare to the milk produced in your breasts and all the useful ingredients it has. The mother’s milk is more easily digestible for the baby’s sensitive digestive system. Also, breastfed babies swallow less air with the milk than the babies fed by bottle, which helps sooth the cramps that babies experience.
Mother’s milk • Has the ideal nutritive combination for each baby, • Reduces the risk of various respiratory and stomach infections, • Reduces the risk of developing chronic diseases, • Is more easily digestible and makes baby cramps less frequent and intense.
Apart from the exceptional benefits for the child, breastfeeding is beneficial for the mother as well, since breastfeeding helps uterus to return to pre-pregnancy size more quickly and lessens the postpartum bleeding (lochia). Breastfeeding releases the hormone oxytocin, also known as the “love hormone”. This hormone arouses the feelings of bliss, happiness and serenity, which is of great importance during the mother and the baby’s first interactions. Perhaps the strongest argument for breastfeeding is the fact that it is a highly intimate act and a foundation for every subsequent emotional exchange between the mother and the baby. Physical contact is essential throughout the whole period of baby’s growing up, but the need for physical contact with the mother is most probably at its strongest at the very beginning. Having in mind that only a short time ago the baby and the mother were practically one, this is not surprising. It is not only food that the baby gets from the mother while being breastfed, but also love and tenderness, which are the signals for the baby that he/she is safe, loved and well taken care of. It must be said that positive feelings and establishing good emotional connection with the child is not something that only breastfeeding mothers can have. Of course, many children that are fed infant formula thrive quite well, both physically and emotionally, even without the mother’s milk. Here I made a list of the advantages of breastfeeding because it seems to me that our mothers give up on breastfeeding rather quickly and easily. That is why I wanted to focus once more on the basic facts about breastfeeding in order to encourage the women who wish to breastfeed but are at risk of giving up for various reasons, such as a lack of support, wrong advice or longer separation from the baby right after giving birth.
Pa r t I – N U TRITI O N
17
Preparation for Breastfeeding At the very beginning of pregnancy, somewhere between the fourth and the fifth week, the woman’s breasts become more sensitive, fuller, sometimes even painful due to hormonal changes. In the later stages of pregnancy the breasts start to grow, while the nipples and the surrounding skin become darker, which is something that, after the childbirth, helps the newborn find the source of food. During the fourth month of pregnancy, the breasts slowly start to produce colostrum, which is the first milk that the baby will suckle in the first days after he/she is born and which differs from the milk that the breasts produce later. Some women may notice it even before giving birth, in the form of yellowish drops or tiny gold plugs in the nipples. All this indicates that your body is preparing for breastfeeding even during the pregnancy. Apart from the “physical” preparations, it is advised that the woman prepare mentally for the new role as well. If you wish to breastfeed your baby, try to obtain relevant information about how to ensure the milk supply, what the possible problems are and how to prevent and deal with them. This book can be a useful guide in obtaining information, and if you happen to have any further dilemmas and questions you can always turn to one of the specialized breastfeeding counseling centers.
Helpers For most of the women who become mothers for the first time the beginning of the breastfeeding process can be rather stressful, even very difficult. That is why any help and support from the people in your surroundings is not just welcome, but often crucial. However, young mothers sometimes get too much help from different sides in our culture. Too much noise and too many people in the house can have a negative influence on a woman who is already very sensitive and often worried about all kinds of things. Apart from that, in this period she is like a magnet attracting everyone to express their opinion, share experience and give recommendations. Unfortunately, many of the tips given to the new mother are outdated, contradictory or just—stupid. It is not just about breastfeeding, but since breastfeeding is the first task set before any woman when she becomes a mother, it seems that the “counselors” are specially motivated to share their comments, insights, suggestions and criticism. It often happens that inadequate help comes precisely from those who are the closest to us and whose intentions are nothing but good. My husband and I decided to avoid that trap, feeling that we should be the ones taking care of the baby. It was to be the three of us: he, baby and I. Our plan sounded very idyllic and romantic in theory. In practice, it turned out to be more complicated than we expected. I will never forget the first night after we brought Vasa home from hospital. Although we sincerely wanted to deal with the new circumstances by ourselves, we were feeling increasingly ill at ease as the night approached. We did not seem to be able to adjust the diaper properly, so we had to change the baby every half an hour and soon we were left without clean sheets, outer contour diapers and inner cloth diapers.
18
T H E F IR S T Y EAR IN YO U R PO C K ET
We were completely helpless and slightly panicking, fearing that, without broad swaddling, Vasa would end up with dislocated hips by morning. Somewhere after midnight, we admitted that we needed help and called my mom, who instantly rushed to a nearby pharmacy and bought a new supply of diapers. We could have handled the situation without diapers, but the extremely important thing that we realized at that point was that we did not have to do everything by ourselves although we wanted to, and that we had people that we could rely on in the moments when we really needed help and support. It is not easy nor necessary to do everything by yourself while you and your baby are getting used to breastfeeding, but one should make an effort and estimate who to ask for help, when and what exactly. At the very beginning there were nights when I simply could not get a grip on myself. I was tired, confused, worried, and from time to time scared. In those moments my husband would suggest that I lie down and have some rest while he takes care of Vasa and feeds him infant formula. His intentions were good, but such arrangements would have probably brought more damage than gain, especially since I was only starting to breastfeed and the adequate “supply and demand” of milk had not yet been established. The quantity of milk that your breasts produce is not just a matter of your body, but of your mind as well. The more the baby suckles, the more milk you breasts will produce. In that way, the baby is the one that determines the amount of milk produced. If somebody else feeds your baby while you are asleep, your brain will fail to obtain the information about the additional quantity that your breasts should produce, and a discrepancy can occur between the amount that the baby needs and the amount that your breasts produce. Apart from that, if you let a longer period of time pass without any milk discharge from your breasts, you are running the risk of having mastitis. Having as much sleep as possible in the first days and weeks of baby’s life is very important, but you should try to organize yourself and your helpers in a way that allows you to find time for naps between breastfeeds, and not during the time that baby needs to be fed. That way you will avoid complications that are very likely to occur. Sometimes, in the middle of the night, while you and your mother or your motherin-law are trying to figure out together why the baby is crying again, they may suggests that perhaps it would be the best thing to try feeding your baby infant formula. They most certainly do not do it to discourage you or to ruin your breastfeeding project. You should have in mind that, when our mothers became mothers, infant formulas were at their peak. They were seen as the perfect replacement for the mother’s milk, sometimes even as a healthier choice for every child. It is no wonder then that our mothers or our mothers-in-law will easily go for the infant formula, convinced that they are doing the right thing. Their intentions are not bad. Their experience is simply different and that is what shapes their attitude to breastfeeding. If you decide to breastfeed, especially if you really care about doing it, you should try surrounding yourself with people who will be of real help to you. The real helpers are the ones that share your positive attitude to breastfeeding and that will provide you with emotional support while you are working on establishing proper milk supply. The real helpers are the ones who will take upon themselves some of your domestic duties, such as going shopping or looking after your older children while you are dealing
Pa r t I – N UTRITI O N
19
with solving potential problems that may occur while you and your baby are trying to establish a feeding pattern. You can find some real helpers in your family, among friends, acquaintances or trained breastfeeding counselors. If you develop a problem such as, for example, mastitis, it is always wise to ask for professional health care in order to prevent any further complications. In the first days upon leaving the hospital, parents are usually preoccupied with taking care of the child. In that phase, many families are unable to follow their usual daily routine since all the activities are completely tailored to the baby’s needs, regardless of the time of day. Still, several weeks after coming home from hospital, every woman should afford an everyday break from the baby care routine of at least half an hour. In that sense, helpers can be of invaluable assistance for every new mother. Ideally, the father should be the one to take care of the baby while the mother is resting. Many men do not feel comfortable with the idea of being alone with a tiny baby, but the fact is that, during these short periods, every father will become more and more competent, relaxed and sure of himself and his role as a father. His engagement is the cornerstone of all the activities that will take place between the father and the child in later phases. By filling in for the mother while she takes some rest, the father helps the mother immensely and has the opportunity to become closer to the child and build a special, authentic relationship. If, for any reason, you are not in a position to leave the baby with the baby’s father, you should try and find a reliable person in your surroundings, somebody who is ready to take upon himself/herself the responsibility. Even a ten-day or a two-week old baby can be without you for a half an hour, and as the baby grows, you can slowly extend the time that you use to relax from your usual duties. It is in no way harmful to your baby; on the contrary, both you and your baby will benefit from it in manifold ways. The important thing is to make use of your free time doing whatever you find satisfying, however it is understood that you will be physically separated from the baby. If you ask somebody to take care of the baby while you are reading newspaper in the same room, it will hardly be to anyone’s benefit. You will not be able to relax completely, and I am quite sure that you will be tempted to rush to your helper’s assistance as soon as you feel the baby is in want of something. By doing that, you are doing yourself a great disservice. You should try and organize a little get-together with your friend in a nearby café, take a walk in the park or prepare a hot bath (on condition that it is really feasible to have some time alone in the bathroom.) Such pauses will for sure make you fresh, which will be advantageous for your baby too, after you come back to your duties as the mother after the pause.
Basic Facts about Breastfeeding Breastfeeding is usually not difficult. Breastfeeding can cause certain problems in some women, but they do not last more than a couple of weeks. If the mother overcomes the problems successfully, breastfeeding becomes an easy routine and a mutually rewarding experience. Our grandmothers, obviously, did not have to learn about breastfeeding the way we do, which leads to a logical question: is so much analysis necessary for something as natural as breastfeeding? After talking to my friends who had problems with the
20 TH E F IR S T Y EAR IN YO U R PO C K ET
milk supply or assuming a correct position while breastfeeding, I came to a conclusion, however, that it is more than necessary to receive some kind of information since many of us, unlike our grandmothers, have never had an opportunity to see proper breastfeeding take place or talk about it with women who have had experience in breastfeeding.
Correct breastfeeding Breastfeeding is natural and mostly instinctive. A woman who has given birth has a natural impulse to clasp the baby to her bosom, whereas the baby’s impulse is to open his/her mouth and instinctively start suckling. Everything else is something that you and your baby have to learn by practicing, repeating and correcting mistakes. You have to feel each other and establish a mutual rhythm, as well as to find the best possible position, even a place where you will feel the most comfortable while breastfeeding. You have to learn what to do with your breasts and your baby, while the baby has to learn what to do with his/her tongue and jaw. This seems like a complicated equation, but the more you practice, the more progress you will make and soon everything will go smoothly, naturally and without thinking. Breastfeeding is like swimming or cycling—once you master it, you will never forget it. My younger son Vukašin was born prematurely and he was placed in an intensive care unit. As I could not breastfeed him for a period of five days, I started fearing that breastfeeding would not go as smoothly as with Vasa. Instead of being breastfed, nurses fed him infant formula as well as my milk with a spoon. I wondered if I would know how to place him properly on my breast. All the apprehension disappeared the moment I first took him in my arms, because everything took its natural course, as if my body had “remembered” all the movements and positions. However, until breastfeeding becomes a pleasurable routine, it is necessary to dedicate the first weeks of your baby’s life to practicing.
The purpose of this book is very simple—it should help young mothers surmount the difficulties starting from the moment their baby cries for the first time after coming home from hospital to their baby’s first year of age as smoothly as possible. Relying on her own knowledge and experience, the author gives advice on three most important aspects of raising a child in the first year of age: • On nutrition, which takes up a lot of time dedicated to the baby (breastfeeding, introducing solid foods, allergies, etc.), • How to encourage a healthy emotional development of your baby, all the while acknowledging the needs of both the baby and the parents, • On play as an important development stimulus, as well as on different ways to play and fill your time with your baby in a pleasant and useful way. Although the author intended the book first and foremost for other mothers—“as a bubble in the ocean of motherly solidarity”—the book offers many tips and guidelines that will also help fathers overcome the difficulties and resolve the doubts encountered in the first year of their baby’s life. ISBN 978-86-529-0111-1
9 788652 901111