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Gestational diabetes affects more women than we think. The question is what can be done from a dietary perspective to assist a mom and baby with gestational diabetes? The higher the pregnant mom’s blood sugars are the greater the risk to her unborn baby. The more glucose fluctuations the greater the risk to the growing baby and the higher the insulin spikes the greater the risks. Here are some nutritional tips for an expecting mother with gestational diabetes 1. Cut ALL sugars, refined starches and white carbs out of the diet. 2. Drink only water, no fizzy drinks or fruit juices 3. Eat a range of fresh veggies, both green and orange veggies. 4. Eat only seasonal, fresh whole fruit. Avoid dried fruit, fruit juices and canned fruits. 5. Keep fruit portions to 3 per day of which berries should make up two portions. 6. Include some healthy fats at each meal and snack time. These would include tree nuts like almonds, hazelnuts and cashews. Include seeds like flaxseeds, chia seeds and sunflower seeds. Olives, olive oil, avocado and coconut fat can be included daily to add healthy and sustainable calories. 7. Protein is very important for placenta health and the growing baby as well as mom. Protein foods include eggs, all meats and fish, dairy products also include protein but make sure they are the least processed available . That means, full cream, unsweetened, no colorants or flavourants added. Yogurt, milk, butter and cream cheeses. 8. Only eat natural unprocessed grains and include a max of two portions a day. These include quinoa, oats, spelt, millet, sorghum. 9. Have three meals and two to three small snacks a day. 10. Include a protein, dairy and/or two green and one orange veggie per meal . At one meal include a grain. And distribute the three fruit portions over the day. Include a fat portion at each meal and snack. Drink lots of fresh water throughout the day! And find ways to manage your stress in a healthy way. Include some light consistent exercise as this also helps manage blood sugar and gives you a sense of well being. Kath Megaw - paediatric dietician and co-author of Feeding Sense

What is normal, what is not? Parenting is a mammoth task, and brings with it a lot of uncertainty as to what is actually within the norm, and what may need more urgent attention. I shall therefore attempt to sketch a picture of what is considered normal, with initial focus on the first few months of life, which are particularly panic-provoking! This includes a few words on the dreaded “C-word”…Colic. I shall then go through system by system what may go wrong and when to seek help. As a paediatric allergist, I have a particular interest in allergy prevention strategies, hence shall attempt to dispel a few myths and iron out some truths about what we can do to reduce allergies in the offspring. What is normal in the first few months? The first few months of parenthood are particularly tough as you take full responsibility for a precious but needy little baby, and have to function on minimal sleep. My advice: accept all the help you can, don’t set your expectations too high, and don’t expect your baby to fit into a mould! This is “survival time” for all- the enjoyment of parenthood will come! For the first 3-4 months babies’ brains and tummies are still very immature. This time has been dubbed the “fourth trimester.” The baby is not yet able to manipulate you hence it is not really possible to “spoil” a baby during this time. However, routines can be established from an early age and it is useful to try have a baby in some kind of a routine of sleep, feeding and play by 12 weeks or so if possible. The predictability of a routine helps you as well as other caregivers as well as your baby. Remember to be flexible and especially adaptable at times of travel, sickness and immunisations when the routine may be disturbed for a while. The first few months are vital for establishing a bond with your baby and a relationship of trust- the baby needs to know that “warmth and food and cuddles will come my way when I need them.” Remember that it is normal for a baby to cry as it is its only way of communicating. Crying increases from an average of about 1 hour a day at birth to 2-3 hours a day at 6 weeks, then slowly decreases again to about 1-2 hours a day at 3 months. Remember this “crying curve” when you are tearing your hair out at 6 weeks post birth! Gripes and Groans in the first few months The immature gut during the first 3-4 months means that most babies have gripes and groans to varying degrees. “Colic” by definition is excessive crying of more than 3 hours a day, more than 3 days a week, typically from 2-3 weeks until 3-4 months of age. Truly colicky babies by definition are thriving and usually have a pattern of an unsettled period, typically (but not always) in the early evening, when they cry inconsolably and may draw their legs up in discomfort. Although the specific cause of colic is rather mysterious, the general feeling is that it may be caused by an immature gut and immature nervous system (oversensitivity). Colic does not cause long term harm or distress to the baby. Simple measures such as winding the baby carefully, holding them upright with gentle pressure on the tummy, movement, driving, “white noise”, wind drops and probiotic drops may be useful. More potent colic mixtures can be sedating hence should be used sparingly only for “crisis” times once or twice a day after discussion with your clinic sister or doctor. Individual colic “medications” do not have a great success rate, and each one may work in only about a third of patients. Therefore, if they do not make a difference after a week or 2, stop them. Time is the great healer for colic, but this is hard to accept when you have a little baba crying 24/7! Some cases of excessive crying and discomfort may be caused by reflux of acid and milk into the throat, lactose intolerance and cow’s milk protein allergy. Please discuss concerns of with your clinic sister and doctor, especially if there is excessive vomiting, constant crying, inadequate weight gain, severe nappy rash, or chestiness. On that note, most babies vomit as they have an immature valve at the top of their stomachs which lets milk go up again. This is normal. Vomiting, in fact, only peaks at 4 months. However, if the vomiting seems excessively painful, the baby back-arches a lot, refuses to lie on the back, and is extremely miserable after feeds or fusses excessively during feeds, reflux “disease” should be considered and discussed with your healthcare practitioner. Stools During the first few days of life the baby passes meconium, which is a black or dark green stool of “marmite” consistency. After a few days, stools change. Breastfeeding stools are normally mustard yellow with white “seeds” of curdled milk. Breastfed babies have a wide variety of stooling habits. In the first few weeks they tend to pass stool after most feeds. After a few weeks they settle into a pattern which is widely variable: from 7-8 stools per day to one stool per week- this is all within normal limits. Babies on predominantly formula feeds should ideally pass stool at least once a day. Babies often groan and strain and become red in the face when they are passing stools- this is normal unless accompanied by painful crying. If you are concerned about constipation- (if stools are infrequent or unusually hard or painful to pass) please consult your doctor. Sleep Sleep is always an issue in families with young kids. We won’t go into detail here as every child and family is so different. Don’t expect miracles before 6 months- the young baby is programmed to require night feeds which can be normal until 8-9 months of age. Thereafter, demanding a milk feed is usually not a nutritional issue but a comfort “prop” to help them fall asleep again. Teaching a child to self soothe is an important tool to impart on your young one and can be done from about 4 months of age. They may need a comforter such as a special blanket, soft toy or dummy (or a combination of these) to help them fall asleep. Babies are generally reasonably easy for the first 10 days or so then may become more difficult as colic and wind sets in. Their sleep requirements are high (about 16 hours a day in total for the first few weeks), gradually settling into a pattern of approximately 3 naps per day by 3 months of age. If possible, some naps should be more than 40 minutes long to provide restoring sleep. At night time they will continue to wake 3-4 hourly for feeds for the first few weeks; by 3 months there is often a longer “stretch” of sleep during the night of 5-6 hours. Remember that the safest sleep position for your baby is on the back. The “back to sleep” campaign in the UK has seen the rate of cot deaths halve over only a few years. If the family is really not coping with the interrupted nights, or if there is a sudden change in sleep pattern, it is worth having the child looked at to make sure there is not a physical ailment disrupting the sleep. The routine and feeding pattern should be examined to make sure the daytime sleep and feed requirements are being met. There are a variety of forms of sleep training available, from controlled checking to gentle gradual separation techniques- please discuss with your clinic sister or doctor before embarking on these. If a child is unwell or going through a stage of separation anxiety, it is not a good time to sleep train. Remember that “this too shall pass” and that most children- even the worst initial sleepers- sleep very well by the age of 5 or 6 years. Feeds Initial feeds should be 3-4 hourly during the day, and on demand at night. Some babies only manage 2 hours in between feeds initially- this should stretch once they are able to drink more at one time. Breastfeeding is ideal for babies for several reasons including cost, convenience, allergy prevention and to boost their immune systems. The clinic sisters have vast experience with breastfeeding, please consult them for advice if you are battling. However, not all mothers manage to breast feeds or have insufficient milk- nothing to feel guilty about. There is a vast choice of formula milks and the approximate volume that a baby needs for the first few months is 150 mL milk per kg per day (divide this volume into the number of feeds per day). For example, a 4 kg baby on formula milk who feeds 3 hourly needs approximately 150 x 4= 600 mL per day; ie approximately 75 mL per feed every 3 hours. (8 feeds per day) Some babies need less milk, some need more- the best way to judge is by their weight gain. For this reason we plot babies’ weights on the growth chart regularly to make sure they are not falling off the growth curve. Babies lose weight during the first few days of life- loss of up to 10% of their birth weight is normal. The baby should regain its birth weight by 2 weeks of age. After that, for the first 3 months or so weight gain should be between 150-350 grams per week. After 3 months it slows down somewhat. Solids can be introduced any time from 4 months (17 weeks) onwards. Throughout the first year of life milk is the most important component of the infant’s diet, and even on 3 solids meals a day, during the first year the infant requires at least 450-600 ml milk per 24 hours. After the age of one, milk can be cut down gradually to 300-500 mL per day- overfeeding with milk after a year of age will interfere with an appetite for solids and may lead to problems such as anaemia. From about 14 months or so many toddlers notoriously go through a fussy eating stage-their growth curve naturally slows down and the world around them is SO much more interesting than food! It is therefore important to try and introduce a great variety of foods to the toddler before the fussy stage begins. Developmental Milestones Every baby develops at a slightly different pace, but generally the sequence of development is similar. Stimulation of a baby’s development will be covered by my colleagues. As soon as the baby starts fussing and seems fed up, stop with the stimulating process so that they can calm down in preparation for the next nap. Below are basic milestones typical at different ages. Remember each child develops at a different pace, and individual babies may be advanced in a certain area e.g, grabbing and mouthing yet a bit slower in other areas e.g. sitting/crawling. If your child is lagging behind significantly please consult the paediatrician: the sooner delays are picked up, the quicker we can intervene to find a diagnosis and treatment. Developmental milestones Age Gross Motor Skills Fine Motor Skills Hearing and Language Development Visual Development Personal/Social Birth Very little head control Hands are closed and grasp reflex present Startles to loud noises -Eyes close in response to bright light -Best distance of vision is about 30 cm away -Black and white vision Cries 6 weeks Moderate amount of head control -Can make tight fists -Places hands in mouth -Responds to sounds by calming, startling or crying -Starts making cooing sounds May follow slow moving objects through 90 degrees Begins to smile in response to familiar face or voice 3 months -Very little head lag -Can lift upper body and head when lying on tummy -Leg kicking and stretching -Standing reflex develops (pushes down on a surface with legs when held up) -Hands held loosely -Inspects hands and grasps objects that are place within hands -Can bring hands together -Recognises and responds to parents -Coos and gurgles -Blows bubbles Follows objects moving up to 180 degrees in the field of vision -Smiles spontaneously -Develops facial expressions to show basic emotions -Recognises mother’s face and scent 6 months -Supports head well -Can support upper body with hands when lying on stomach -Sits with support -Can roll over -Reaches for and grasps objects -Places objects in mouth -Transfers objects from hand to hand -Responds vocally when spoken to -Uses sounds such as squealing or laughter to express emotions -Uses repetitive monosyllabic sounds like bababa Can move eyes in all directions Recognises toys 9 months -Sits without support -Crawls on stomach and then on hands and knees -Starts to pull body into a standing position -Can pick up, shake and drop small objects -Grasps food and places in mouth -Holds a bottle Begins to point Starts imitating sounds -Stranger anxiety- Knows and trusts a limited number of caregivers -Recognises own name 12 months -Cruises around furniture -Starts to walk (walking may take up to 18 months) -Begins to throw objects -Good pincer grip -Holds 2 objects and bangs together -Still mouths a lot -Speaks 2-3 words -Makes sounds at toys Picks up tiny things from the ground -Searches for hidden or fallen toys (0bject permanence) -Waves goodbye, - points -Shakes head 15 months -Walks steadily -Starts to climb Stacks 2- 3 blocks Speaks 3-4 words -Has temper tantrums when frustrated -Becomes attached to a soft toy or other object 18 months -Walks steadily. -Runs -throws ball underhand -kicks -Scribbles -Stacks 3-4 blocks -Speaks 6-8 words -May have some 2 word phrases As above -Starts to use fork and spoon -“reads” picture books on his own 24 months -Runs -Jumps with 2 feet -Walks down stairs one foot at a time -stacks 6 blocks -scribbles -may still use both left and right hands to draw -Names at least 6 body parts -Uses 2-3 word sentences -Half of speech understandable -Starts to learn some colours Adult visual acuity -Asks “why?” -Begins to show interest in playing with other children but finds it difficult to share. Play is often in parallel -Helps with dressing -Uses fork and spoon 30 months -Jumps easily -Balances on one foot for a few seconds -Walks down stairs with alternating legs -Draws vertical line and circle -Pencil grip starts to develop -Handedness becomes evidence -Able to name some colours and shapes -2-4 word sentences -Able to recite name -Able to brush teeth with assistance -Washes and dries own hands 36 months -Hops on one leg -Rides a tricycle -Copies a circle -Shows definite handedness -3-4 word sentences -Able to follow 2-3 word commands -Starts to play with other children -can name a friend -Able to help with dressing Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

Allergy prevention strategies Allergies of all sorts (asthma, hayfever, eczema and more recently food allergy) have increased dramatically over the past few decades, and we find ourselves in the middle of an “allergy epidemic.” A child without any family history of allergies is now at approximately 15% risk of developing an allergic condition within the first few years; if one parent has an allergic condition, the child is at 40-50% risk of allergies, and if both parents are allergic, this increases to 60-80%. Having a sibling with allergies also carries an increased risk of allergic conditions developing. There are many confusing messages on allergy prevention- the following are the ones with Scientific backing that we currently recommend: During pregnancy Eat healthily and don’t smoke No need to cut out on any food groups for the sake of allergy prevention- it does not reduce allergy in the offspring Try eat 2 or more portions of oily fish per week If you are unable to eat that amount of fish, then consider taking omega 3 supplements Consider taking probiotics in the last trimester if your child is at risk of allergies (ie if there is a family history of allergy in parents or siblings) Feeding the newborn baby Breast milk is best and has allergy prevention properties The Department of Health recommends exclusive breastfeeding until 6months of age. Prolonged feeding over 6 months has no further allergy prevention properties (but of course has other benefits) Continuing to breastfeed whilst the first solids are introduced has some benefit In high risk babies consider giving a daily probiotic and prebiotic for the first 3-4 months (no absolute proof of this yet- but looks promising) Solids introduction Solids should be introduced when the child shows signs of readiness. There is no evidence that delaying solids prevents allergies- in fact it may increase allergies After 6 months you do not need to hold back on anything – you can give dairy, peanut, egg, wheat. Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

Managing cracked and bleeding nipples This is a common reason for throwing in the towel with breast feeding due to excessive pain and discomfort with feeding. The most frequent cause of cracked nipples is incorrect latching of the baby’s mouth onto the nipple. Thrush (see above) can also cause very painful nipples. Make sure that your baby is latched onto the breast correctly, with both top and bottom lip in a snug seal around your nipple. Your pain level will indicate to you if your baby is latched correctly or not! To release the suction on your beast so that you can take your nipple out of his mouth, insert your finger into the corner of his mouth and gently withdraw your nipple from his mouth, and try to relatch him successfully. Using a nipple shield (available from your pharmacy or baby shop) during feeding gives cracked and bleeding nipples time to heal. Speak to your clinic sister or doctor to recommend a nipple cream to assist with healing. Exposing your nipples to some sunlight also helps to hasten healing (easier said than done!). Expressing breast milk and offering it to your baby from a spoon or a bottle is also a way to let your nipples heal whilst continuing to breast feed. Is my milk strong enough? Don’t listen to old wives tales about your milk being too strong or too weak. It is not the quality of the milk that makes the difference, it is the quantity. Some moms just do not have enough milk to satisfy their baby. This is why it is important to weigh your baby frequently to ensure that she is growing adequately. If your baby is gaining weight, having at least 6 wet nappies a day, and is relatively happy in between feeds which may be very frequent in the early days, lengthening to a few hours after a few weeks; then you can rest assured that you have enough milk. However, your stress and anxiety, a poor diet and inadequate fluid intake all play a part in hampering breast milk production. Make sure you are eating enough protein, such as meat, eggs and beans (you need to increase your protein intake three fold whilst breast feeding), drinking at least a liter of fluid a day and that feeding times are relaxed and calm. The main hormone that ensures adequate milk production (oxytocin) is controlled by emotions, so if you are anxious and upset at feed time, this important hormone will be affected, and you will produce less milk. Managing sore and engorged breasts This typically happens around day 4 after delivery (slightly longer after a caesarian birth). Most new moms are usually at home by now and do not have the support and care of the nursing staff in the maternity units to help them through this difficult time. Your breasts will become full and heavy, and excruciatingly tender to the touch. In some instances, they become rock hard, hot and sore. This is what is commonly known as “milk coming in”. It usually settles after 72 hours. Feed your baby on demand, as normal, and don’t be tempted to express your breasts to make them emptier and softer – all you will do is encourage more milk to be produced! Place cabbage leaves in your bra (they really do work), rub arnica cream or oil onto your sore and swollen breasts, and take an anti-inflammatory medication to help with the pain and swelling (ask your pharmacist, clinic sister or doctor to recommend one that is safe for breast feeding). Applying ice packs also helps with the pain and inflammation. Persevere, it will get better – just give it some time, and don’t expect your breasts to settle down for at least a few days. By Sr Ann Richardson Sr Ann Richardson is the author of Toddler Sense and also co-authored Baby Sense and Sleep Sense. She is a qualified nurse and midwife and has worked in the midwifery and paediatric fields for 30 years. For more information from Sr Ann Richardson go to www.toddlersense.com or email her at info@toddlersense.co.za

Health authorities like the World Health Organisation confirm that exclusive breastfeeding (in other words feeding baby nothing but breastmilk) is ideal for the first six months. In order to reach this goal, most moms will need to express breastmilk at some time, whether because they have to return to work, leave baby with someone else, relieve engorgement or stimulate milk supply. Manual expression or breastpump? This depends on your needs. If you are expressing for a premature baby, rent a hospital-grade electric pump with a double collection kit in order to properly stimulate your milk supply. If you will be expressing two or more feeds per day once you return to work, a double electric breast pump is ideal and time-efficient. And if you only plan to express once in a blue moon? In that case a manual pump or hand expressing will do the job just fine. Your let-down reflex Breastmilk is produced by and stored in special milk-making cells in the alveoli (hollow structures resembling clusters of grapes).Around each alveolus is a basket-like network of muscle cells. When the nerve endings in your areola (the dark area around your nipple) are stimulated, your brain releases oxytocin. This hormone contracts the muscle cells around the alveoli, squeezing the milk into the ducts that lead to the holes in your nipples. This process is called the let-down or the milk ejection reflex, and without it no milk is available. The let-down is a conditioned reflex. It occurs when baby suckles, but can also be triggered by other stimuli. Any breastfeeding mom knows that her milk often starts flowing when she hears baby cry or merely thinks about him. In order to express milk, you will need to condition your breasts to respond to hand expression or a breast pump. For this reason, most moms only get a few millilitres – or even a few drops – the first time they express. Don’t be discouraged, practice makes perfect. Before you start Wash your hands thoroughly with soap and water. Sterilise any equipment you are using. Massage your breast gently and place a warm facecloth on it to stimulate milk flow. If you are away from baby you can increase milk flow by thinking about him, looking at a photo, recording his cry on your phone and replaying it, or smelling a blankie or article of clothing with his smell. How to express by hand Cup your breast tissue between your thumb and the rest of your fingers. Place your fingertips just behind your areola. Squeeze your breast tissue backwards, towards your ribs. Press your fingers together and roll as if you are making fingerprints.Release the pressure and repeat the process in a rhythmical fashion. It may take a minute or two to trigger a let-down reflex. When the milk stops flowing, rotate your wrist to place your fingers on a different section of the breast. Repeat on the other side. Hand expression should not hurt. Don’t slide your fingers along the skin as the friction may damage your tissue. Don’t compress your nipple as the milk is not stored there, but further back in the breast tissue. Many moms find it easier to hand express into a wide-necked container than into a bottle. Using a breast pump Buy your own, do not use second hand pumps. Choose a flange that is well-suited to your nipple size. You should see space around the nipple and the areola should not be pulled into the flange tunnel during pumping. Friction on your nipple or areola can damage the sensitive tissue. Apply warm moist heat and massage your breast before pumping to encourage the let-down reflex. Centre your nipple in the flange and turn the suction down to the lowest setting. Switch the pump on and adjust the suction. It should be strong but never painful. The milk will start flowing once your let-down is triggered, usually after a minute or two. Keep pumping until the flow stops. It usually takes at least 15 minutes to pump with a good quality double electric pump and even longer with a single or manual pump. Storing breastmilk Store breastmilk in plastic or glass containers and seal with a lid. You can also buy plastic bags designed especially for this purpose. Do not fill the container all the way – allow for expansion. Store and defrost the amount your baby will normally take (usually 65 to 125 millilitres per feed) in order to avoid waste. Write the date on the container and use the oldest milk first. You can safely store expressed milk in: A cooler bag with ice bricks for up to 24 hours; A fridge for 5 days; The freezer compartment of a two-door refrigerator for two weeks; A chest freezer for up to six months. Defrosting breastmilk Defrost breastmilk in lukewarm water, never at room temperature or in the microwave. It is normal for expressed breastmilk to separate into layers. The bottom may have a bluish colour while the top layer is yellow and creamy. After thawing, gently shake the container to mix the fat back in. Feed it to baby straightaway. Never refreeze thawed milk. by Marie-Louise Steyn, the author of ‘Breastfeeding your Baby’ (Metz Press)

What is colostrum? Colostrum is the milk produced in your breasts from about 16 weeks of pregnancy until around the third day after your baby’s birth. Some moms notice drops leaking from their breasts in the weeks before the birth, others don’t. Rest assured that your breasts are producing colostrum in preparation of baby’s arrival – whether you see it or not.Not leaking certainly does not mean that you won’t have a plentiful milk supply. Your body continually produces colostrum, so don’t worry that leaking will lessen baby’s supply. Colostrum is a thick, sticky fluid. Although it may also be white or even translucent, it is most often a buttery yellow. Regardless of the colour, colostrum is so precious that lactation experts fondly call it “liquid gold”. The perfect first food Colostrum is a superfood, tailor-made for a newborn’s needs. It is highly nutritious yet extremely easy to digest. A newborn’s stomach is only about the size of a marble. It can hold around 5 - 7 milliliters of milk on the first day, and initially it cannot stretch. This is why the low-volume, highly concentrated liquid gold is so perfect. Consider your colostrum baby’s “first immunization”. It is extremely important for your little one’s immature immune system. Some experts estimate that up to 60% of a newborn’s immunity comes from colostrum. It is packed with an antibody known as secretory immunoglobulin A (sIgA), and every drop teems with white blood cells (leukocytes) that defend your vulnerable baby against viruses and bacteria. For this reason, colostrum is extra important for premature babies. Colostrum is excellent for your baby’s digestive system. A newborn baby is born with what we call a “leaky” or highly permeable gut. There are gaps between the cells lining the mucosa. It is through these gaps that viruses, bacteria and allergens enter baby’s body. Colostrum plugs up these gaps like putty so that no harmful pathogens can pass through. This permeability of the gut explains why exclusive breastfeeding (giving your baby nothing but breast milk), is so important for the first six months. If Baby ingests anything else – even a little water – this seal is broken and takes up to 4 weeks to close again. How colostrum helps prevent jaundice Your first milk is a natural pro-biotic and laxative. It will help baby get rid of the tarry black meconium that has built up in his bowels during his time in the womb. Pooing early and often lessens baby’s risk of newborn jaundice, and here’s why. Babies are born with extra red blood cells. These cells are the body’s oxygen carriers. In order to ensure that baby’s brain gets enough life-giving oxygen throughout the birth process, his body produces extra red blood cells right before birth. Call this Mother Nature’s insurance policy. As soon as he is born, though, he no longer needs those extra red blood cells. His liver breaks them down into a waste-product called bilirubin, which is excreted through the stools. If baby breastfeeds early and often after birth, the laxative properties of colostrum will help him flush out the bilirubin. If he doesn’t feed well (for whatever reason), the bilirubin is reabsorbed from the bowels and builds up in his body. This stresses his immature liver. If the bilirubin build ups to higher than normal levels, baby may need photo-therapy (special lights that break down the bilirubin) at home or in hospital. Newborn jaundice is your classic vicious cycle: baby doesn’t feed well and becomes yellow as a canary. The high bilirubin levels make him sleepy and lethargic and even less likely to feed well. So he becomes more jaundiced and feeds even less … See what I mean? Baby really needs adequate volumes of colostrum early on. Prevention is much better than cure. Giving baby the best start It is impossible to overstate the importance of nursing as soon as possible after birth. Babies are primed to feed in the first hour of life and so are your hormones. Early and frequent feeding is the best way to establish a plentiful milk supply, optimise baby’s growth, and prevent jaundice. Text box Around two hours after birth, babies usually fall asleep. Remember that a newborn can feed even when he is asleep or drowsy – in fact, they often feed more efficiently while in a light sleep and before they are too hungry. Help, my baby doesn’t want to nurse! Some babies are especially sleepy, perhaps due to a stressful birth or the pain medication their moms needed during or after labour. Don’t panic, there are ways to coax these sleepyheads to the breast. First of all, spend lots of time with baby lying your body. Relax, lean back, and put baby on your chest. This position usually triggers a newborn’s feeding reflexes. If the two of you can be skin-to-skin, with baby wearing only a nappy, it works even better. He will be nice and toasty, your breasts are your body’s built-in incubators and can warm up or cool down in order to regulate baby’s temperature. Amazing, right? Skin-to-skin contact also keeps his blood sugar more stable, plus it allows him to smell your milk. If this does not work, baby might need more encouragement. Hand express a few drops of colostrum into a clean teaspoon. Ask the nursing staff or your midwife for help.Try putting a warm facecloth on your breast before expressing, this will encourage milk flow. Important: don’t be discouraged if you only get a few drops, this is all baby needs.His tummy is minute and one swallow is made up of a whole 0.6 milliliters! Now spoon feed the colostrum to baby, or give it to him with an eyedropper or syringe. Often the sweet taste and the quick energy boost will be enough to wake him up and get him nursing. If not, consider contacting a lactation consultant in your area for help. What happens next? On the third or fourth day after birth, your breasts will start feeling warmer and fuller. This means that your more mature, more plentiful milk supply has “come in” to meet baby’s changing needs. This mature milk is less concentrated, but it is still Nature’s perfect food that will help your little one reach his full potential: physically, intellectually and emotionally. Marie-Louise Steyn is the author of ‘Breastfeeding your Baby’ (Metz Press).

The underlying principle when it comes to feeding is not which method you use to feed your baby, but that the choice is right for you both. Let’s start by discussing the two methods, breast- or bottle feeding, available for feeding your child. Breast is best In the young baby (under 6 months), from a nutritional point of view, breast is best. There is no better food for your baby than your own breast milk. The milk that you produce will always be right for your baby. Further benefits are: Breastfeeding until six months helps prevent allergies later on in baby’s life Breast milk is always the right temperature and is easily digested Breastfed babies seldom have problems with constipation or diarrhoea Breast milk doesn’t cost anything! Breast milk contains antibodies to boost her immune system Breast milk perfectly meets your baby’s nutritional needs Tips for best breastfeeding Feed your baby in a quiet, calm environment Take an extra minute or two to get yourself organised before feeding your baby Find the most comfortable position in which to feed Make sure that your baby is latched onto the breast correctly, with both top and bottom lip in a snug seal around your nipple To release the suction on your beast so that you can take your nipple out of his mouth, insert your finger into the corner of his mouth and gently withdraw your nipple from his mouth Allow a maximum of 40 minutes per feed Breastfed babies often need a minute or two in between sucks to catch their breath Breastfeeding works on a supply and demand basis – the quantity of breast milk produced is directly related to how much your baby sucks If breastfeeding doesn’t come naturally to you, and you are starting to feel rather desperate, remember that it takes up to six weeks to establish a feeding routine and corresponding milk supply. However, if your struggle with breastfeeding starts to affect your mood and bonding with your baby or relationship with your partner, stress you out or cause depression, it may be time to reconsider your options. Making feeding time a soothing time By getting in tune with your baby’s senses, you can meet her needs and avoid unnecessary fussing and crying. You’ll also have a more relaxed baby, whose needs are met. “From the moment you lift your baby into your arms and throughout the feed, each one of his senses will be stimulated. TOUCH Your touch HEARING Your voice and heartbeat SIGHT Seeing and focusing on your face and what is around him MOVEMENT Being lifted into the feeding position SMELL The smell of your milk and ‘mother space’ TASTE Whether the milk is sweet or sour, hot or cold INTEROCEPTION The inner sensations of hunger, satiety and gas.” Follow these sensory guidelines to make feeding time a soothing sensory experience for both of you. Keep your baby’s sensory environment the same each feeding time Be cautious with any extra sensory input, like talking or touching. She needs to keep all her attention on sucking, swallowing and breathing As you alternate breasts when breastfeeding, alternate sides when bottle feeding. This ensures she gets equal sensory input on both sides of her body Keep your voice soothing and keep anxiety at bay when feeding “Don’t wear perfume for the first months of your baby’s life” as it could over stimulate him when you are feeding Watch how baby reacts to the taste of your milk. Garlic can change the taste of your milk, so cut that out, or she may not like the taste of the formula you’re using If there’s too much stimulation at feeding time, your baby could react by not feeding well. Ensure a consistently quiet and calm environment at feeding If wind stimulates your baby’s senses during feeding so that he stops feeding, let him break wind and then carry on feeding Reciprocate your baby’s sensory signals. If she looks at you, return eye contact, but look away when she looks away to allow her ‘sensory space’ to focus on feeding. Option Two: hitting the right formula If you have made the decision to start feeding your baby formula, or have been forced to do so because of medication you are taking or a return to work, rest assured that with today’s wide choice of milk formulas… you can ensure that your baby will be well fed. Infant formulas today are highly advanced and are available as hypo-allergenic, lactose-free, cow’s milk protein-free, anti-reflux, soya bean protein feeds and pre-acidified – among others! Ask your paediatrician or clinic sister to help you choose. The right formula Follow these guides for successful bottle feeding. Don’t give cow’s milk to children under one year old. It contains too little iron and the Vitamins A,C and D. It’s also difficult to digest and too high in sodium It may take a few formula changes before you find the one that is best for your baby. Try a new formula for at least 48 hours before changing to another. If your family has a strong history of allergies, take this into consideration when choosing a formula Follow the manufacturers preparation instructions perfectly. Sterilise all your bottles and teats. When bottle feeding, hold your baby close to you as though breastfeeding. This will facilitate skin-to-skin contact, and allow her to feel your face and neck Allow a maximum of 40 minutes per feed If you can hear your baby gulping the formula, she’s probably drinking too fast and this could cause cramps and wind. Adjust the flow by changing the teat or adjusting the bottle angle The right amount of formula In Baby Sense, we advocate the following calculation: 150ml milk per kilogram of the baby’s body weight, divided by the number of feeds you are giving in 24 hours. So if your baby weighs 5kg, and you feed him six times in 24 hours: 5 x 150 = 750ml / 6 = 125ml per feed. This is a guideline only. Some really hungry babies demand 200ml per kilogram of their body weight, while others may do well on 120ml per kilogram of body weight. If he… still looks hungry… try an extra 25ml… and see how he reacts.” Your baby will experience growth spurts at around two weeks, six to eight weeks, and 12 to 14 weeks. These spurts will last for 24 to 48 hours, during which time they’ll be grumpy, restless and feed more often. Once you’ve ruled out other factors, just feed your little one more and know that it will soon pass. By Sr. Ann Richardson

Your baby needs only milk (either breast milk or formula milk) as his main source of nutrition for the first few months of age. Some babies need the addition of some solid food from age of about 6 months or older, and that is usually when one introduces some cereal, vegetables and fruit. So, let us look at what happens when your baby reaches this magical age, of saying “goodbye” to being a small infant, and starts to enter the world of being an “older baby”! Your baby is now a real little person, sitting up and reaching out, laughing and chuckling and is starting to show a real interest in food. This is the time when the main nutrition is derived from solid food, and the emphasis from breast / formula milk moves. Your baby now needs PROTEIN in his / her diet. Protein builds healthy bones and tissue, and is vital for the growth and development of all children. Protein is also filling, so if your baby is still waking at night for feeds, the chances are that he is not getting adequate protein in his diet during the day. Follow these simple guidelines towards increasing his protein intake, and night feedings will become a long distant memory! Your baby’s minimum protein needs in his solid food is calculated on approximately 1g (1 serving) of protein per kg of body weight. The average 6 month baby weighs in the region of 6 – 9kg, so he will need a minimum of 6-10 servings per day, divided into his 3 meals.. Try and incorporate 2 - 4 servings of protein per meal. 1 serving = 1 heaped teaspoon, or a liberal pinch (approx 1g). Remember to always include a variety of fruit and vegetables into his diet, as well as carbohydrates e.g. Cereal or porridge, or pasta, potato or rice. Your little one also needs to start taking a daily iron supplement. Babies are born with iron stores, but by the age of 6 months, they have used them all up! It is important to add an iron supplement to his diet from now on. Ask your clinic sister or pharmacist to recommend one. Protein can be derived from either vegetable or animal sources, so it is really up to you what proteins you would like to start incorporating into his diet (see list below). Your little one will also let you know what his preferences are, so be guided by his likes and dislikes too! Vegetable Protein: Animal Protein: Avocado Pear Yogurt (plain white variety) Cashnut butter/ Macnut butter Cottage Cheese Ground Almonds Crème Cheese (Kiri, laughing Cow, Danino soft cheese etc) Peanut Butter Grated hard white cheese (mozarella, tussers etc) Lentils Butter (not margarine) Samp Egg (yolk to start, 4-5 per week / whites only from 9 mths of age) Soya beans / tofu Tuna fish Sugar Beans Pilchards / Sardines / Salmon / Hake / Kingklip Barley Chicken / livers (free range) Mung Beans Topside mince or grated biltong White kidney beans Ostrich / Lamb Chick Peas Turkey or Veal Sesame/sunflower/pumpkin/linseed seeds Tahini (sesame extract) Butter beans / baked beans Dates FOODS TO AVOID IF THERE IS A STRONG ALLERGY FAMILY HISTORY, OR IF YOUR BABY IS ALREADY SHOWING SIGNS OF ALLERGY: All nuts Dairy Wheat Eggs Fish GUIDELINE FOR A RECOMMENDED DAILY SCHEDULE: 06.00 : Breast / Formula Feed 08.00 : BREAKFAST: Cereal / Porridge - Oats, Mealie Meal, Taystee Wheat, Mabella, Millett etc. Add 2 - 3 proteins e.g. cottage cheese / peanut butter / milk / Tahini / yogurt / almonds / dates etc. OR - Egg OR - Fresh fruit, yogurt and ground almonds / date paste 10.00 : Diluted juice and Snack 12.00 : LUNCH : Avo mashed with soft cheese and banana. OR - Pasta, potato, mabella, corn, rice / fish bake, with white or cheese sauce, cottage cheese etc. OR - Egg OR - Veggie / bean soup and bread OR - Fresh fruit, yoghurt and almonds / date paste 2pm: Breast / Formula feed 3 - 4 pm: Diluted juice and Snack 5 pm: DINNER: Chicken Broth and veggies Bath, Breast / Formula Feed, Bed! On this diet, baby is quite capable of going for 10 - 12 hours at night without needing nourishment. HAPPY SLEEPING! By Meg Faure

Picky eating is such a broad term and something that may mean different things for different people. So what actually is a picky eater? A picky eater is a child who will have a decreased range of foods but still eat quite a variety. Foods are eaten for a while and then lost due to ‘burn out’ and then often regained after a break from that food. Picky eaters are often able to tolerate new foods on their plates even if they won’t eat them but will be selective about what they choose to taste. A picky eater will most often eat at least one food from each of their food groups but will most likely favour one or two food groups over the others. The risk with picky eaters is twofold - both nutritional and emotional. If your child is consistently avoiding a whole food group eg the fruit & veggie group then he will be at risk of certain key vitamins and fibre. If this is ongoing you as a parent are likely to become stressed and this will lead to a stressed out feeding environment and unhappy eating time. (Emotional fallout). To put it simply, during a picky eating phase it is important to supplement the missing food group by adding a good multivitamin. If you feel your child is missing out on energy (eating too little overall) as well as avoiding a whole food group then adding a milk supplement for picky eaters may assist you in managing this phase to avoid added stress around meal time. You need to diffuse the situation and avoid food battles at all costs. Remember your responsibility is when, where and what you feed your child and your child’s responsibility is how much they eat. It is a phase, which will pass, maintain their health with the use of good sound supplements if necessary and relax as they explore foods and find out their own likes and dislikes! By Kath Megar