Good to know

Teething

Teething, is the normal process of new primary teeth working their way through the gums. Teething usually begins at between 4 and 9 months. However, every baby is different in the start and duration of the teething process can vary greatly between babies. Some dentists have noted a family pattern of "early," "average," or "late" teethers.

 

The general order of eruption of primary teeth is:

Teething symptoms vary from baby to baby and are summarized as follows:

  • Obvious symptoms: increased saliva, drooling, wakefulness, swollen or inflamed gums, loose stools, crankiness, crying, biting, chewing and tender gums.
  • Less obvious symptoms: refuses food or may not be drinking milk; your baby may have a rash around the mouth (chin rash); saliva irritates the delicate skin.
Caution: Blaming teething for fevers can lead to a delayed diagnosis of ear infections, urinary tract infections, meningitis and other infections.  (American Academy of Pediatrics)
 

How can I help my baby reduce the pain?

  • Teething Rusks
  • Teething rings
  • Teething gel
  • Natural teething remedies
    • Cold pieces of fruit or vegetables
    • Entertain your baby
    • Various herbal tinctures
Infants Weaning

Breast milk is the best source of nutrition for your baby and after the first few months of life your baby's needs are no longer met entirely by your breast milk. So around the age of six months solid food should be introduced in a simple way as follows: Foods

  • Start with a single grain iron-fortified infant cereal such as rice. Rice cereal is a good first choice since it is easy to digest and least likely to cause allergies.

  • Wheat cereals are the second cereals to be introduced since some babies may be allergic to wheat.
  • Mixed cereals should be introduced after an infant has tried all the single cereals grains.
  • Pureed vegetables can be introduced; mild tasting vegetables such as carrots, sweet potatoes and green beans are introduced first. Often vegetables are given before fruits so baby will not expect all foods to taste sweet.
Note: Iron deficiency is a common problem among babies in the second half of the first year of life so iron fortified infant cereals should be given to infants for the first 2 years of life to ensure an adequate iron intake and to compensate babies iron storage that starts to deplete by the age of six months.
 

Tips for a successful weaning:

  • Choose a good time of day for your baby to start on solids and allow enough time to enjoy this experience.
  • Don't force food on your baby. If they don't want to try a food, stay calm, take the food away and offer it again later.
  • Use a silicon spoon; it's kinder on baby's gums.
  • Always stay with your baby when they are eating.
  • Always test the temperature of food before you give it to your baby - it shouldn't be too hot preferably 37C°.
  • Encourage self feeding. As your baby develops and shows signs of wanting to feed independently give them a spoon or finger foods or Rusks to try.
Natural Honey

Honey is a delicious natural sweeter; it has several health benefits that go beyond its great taste such as natural remedy and energy booster. Although, honey should not be fed to infants less than one year of age because of the risk of infant botulism, since honey may contain Botulinum spores by Bacterium Clostridium botulinum (a toxic bacteria).  

Infant botulism is a type of food poisoning that can result in death because infants do not have a completely matured digestive system and are more susceptible to botulism food poisoning. Botulinum spores are rarely available in pasteurized honey due to the heat process and as a result, parents need to be cautious about processed foods containing honey, which is probably unpasteurized.

Gluten Free

What is Gluten?

Gluten is a protein made up of glutenin and gliadin and is responsible for the elasticity of bread dough. Wheat contains a higher amount of gluten than any other grain, but it is also found in barley, rye and -to a lesser degree- in oats.

Foods that commonly contain gluten include bread, pasta and flour.

What digestive problems are associated with wheat and gluten?

Wheat Allergy

True wheat allergy is uncommon and should not be confused with wheat intolerance. A wheat allergy is a response from the immune system to certain wheat proteins. It is identified quite easily because reactions usually take place within 2 hours - and sometimes only minutes - of wheat being consumed.

Signs of an allergic reaction include

  • Rashes
  • High fever-like symptoms
  • Breathing difficulties (sometimes severe)

 

Wheat intolerance

Intolerance is not an allergic reaction, but occurs when the body has difficulty digesting certain foods. Wheat intolerance is more common than wheat allergy and can cause quite severe gut reactions.

Although allergies may be outgrown, intolerances to certain foods are usually life-long, so the troublesome food has to be permanently avoided.

 

Celiac Disease

Celiac disease (also known as gluten enteropathy or gluten intolerance) is a life-long intolerance to gluten. This means that a person with celiac disease cannot eat wheat, barley, rye, oats, or any food containing them. Celiac disease is a serious condition, where the body's immune system mistakenly treats gluten as a harmful substance. Eventually, damage to the small intestine prevents it from processing the nutrients from other foods. This leads to serious nutritional problems. Celiac disease tends to run in families.

The symptoms of celiac disease in babies tend to be spotted between 9 and 18 months of age and include:

  • diarrhea
  • weight loss, or poor weight gain
  • anemia
  • lack of appetite
  • malnutrition
  • bloated stomach
  • restlessness and irritability
  • dermatitis (itchy rash)

When to introduce wheat and other foods containing gluten to the baby?

The UK Department of Health states that these foods should not be introduced before baby is at least 6 months of age and should NEVER be used as first weaning foods for a baby with a family history of celiac disease or allergies. There are no official recommendations currently available in the US.

Experts believe that introducing gluten to a baby's diet during the first 3 months of life increases the baby's risk of developing celiac disease by 5 times. It also indicates that the risk is high if the introduction of gluten is delayed past 7 months.

After 6 months of age, foods containing gluten are given to baby regularly in normal, adequate amounts. This is so that any adverse reactions can be easily spotted and identified. If baby is only fed small amounts of foods containing gluten - or fed them very infrequently - the pattern of symptoms may be inconsistent, delaying diagnosis.

Safe Preparation, Storage and Handling of Powdered Infant Formula

Breastfeeding Recommendation

Breastmilk is the only source of nutrition which is required until six months of age. These recommendations are for parents/guardians who have decided not to (or cannot) exclusively breastfeed.

How to prepare a feed using powdered infant formula?

  1. Clean and disinfect a surface on which to prepare the feed.
  2. Wash hands with soap and water, and dry using a clean cloth or a single-use napkin.
  3. Boil a sufficient volume of safe water. If using an automatic kettle, wait until the kettle switches off; otherwise make sure that the water comes to a rolling boil. 
    Note: bottled water is not sterile and must be boiled before use. Microwave ovens should never be used in the preparation of powdered infant formula as uneven heating may result in 'hot spots' that can scald the infant's mouth.
  4. Taking care to avoid scalds, pour the appropriate amount of boiled water, which has been allowed to cool slightly, but not below 70 °C, into a cleaned and sterilized feeding cup or bottle. The temperature of the water should be checked using a sterile thermometer.
  5. To the water, add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make infants ill.
  6. Cool feeds quickly to feeding temperature by holding under a running tap, or placing in a container of cold water or iced water. Ensure that the level of the cooling water is below the top of the feeding cup or the lid of the bottle.
  7. Because very hot water has been used to prepare the feed, it is essential that the feeding temperature is checked before feeding in order to avoid scalding the infant's mouth. If necessary, continue cooling as outlined in step 6 above.
  8. Discard any feed that has not been consumed within two hours.

Are there risks with infants consuming under or over concentrated formula?
When preparing powdered infant formula, it is important to follow the instructions for proper amounts of water to add. Always use the proper amount of formula and water recommended on the formula can unless otherwise prescribed by a pediatrician. Adding more water than recommended reduces the caloric value of the formula, which can cause protein energy malnutrition.

In addition to inadequate calorie consumption, consuming an abundant amount of overly dilute formula can lead to water intoxication.

 

What is the hygienic practice before preparing the feed?
The person preparing the feed should clean and disinfect the preparation surface and wash hands with soap and water before preparing a feed. This is because harmful bacteria can be carried on hands and can also be present on surfaces. Washing hands and cleaning and disinfecting surfaces reduces the risk of feeds becoming contaminated during preparation.

Hands must also be washed after using the toilet and after diaper changing because harmful bacteria, have been found in the urine and stools of infants. These bacteria can easily be carried on the hands and contaminate feed during its preparation.

 

Until what age does water need to be sterilized for healthy term infants?
Water used in infant feeding should be sterilized for infants less than four months of age.

 

Can bottled water be used to prepare infant formula?
Commercially bottled water (excluding carbonated and mineral water) can be used to prepare infant formula. However, bottled water is not sterile and therefore must be boiled (to sterilize) until an infant is four months of age.

 

Can you sterilize water by boiling in an electric kettle?
Water can be sterilized in an electric kettle without an automatic shut-off. Kettles with an automatic shut-off should not be used as they turn off once the water comes to a boil and will not allow water to be at a rolling boil for two minutes.

 

Are antibacterial soaps or special cleaning products needed to wash feeding equipment?
No, feeding equipment can be washed with regular dish soap and hot water to remove residue. For infants less than four months of age, equipment should be sterilized in a pot with boiling water for two minutes.

 

How should cans of powdered infant formula be stored?
Powdered infant formula should be stored in a cool, dry place (not in the refrigerator) with the lid tightly closed. The scoop should be dry before placing back in the can. The date that powdered infant formula is opened should be recorded on the lid. Powdered infant formula should be used within one month of opening. Powdered infant formula which has passed the expiry date should not be used.

 

What is the recommended way to store prepared infant formula?
It is preferred to prepare formula for immediate use, however, if formula needs to be prepared ahead, an option for preparation for later use is provided. Feeds should be stored in a refrigerator immediately after preparation. Refrigerators should remain at ≤4 °C to prevent or slow down growth of harmful bacteria.

Infant formula should not be held in the refrigerator door as this section has been found to have higher temperatures than shelves in a refrigerator.

 

What are the warming and holding time recommendations for infant formula?
Infant formula should be prepared for immediate use. If it is not possible to prepare for immediate use, infant formula prepared earlier and stored in the refrigerator should be removed from the refrigerator just prior to feeding to decrease the risk of bacteria growth. Warming formula can be done with a bottle warmer or by placing the bottle in a container of warm water. Formula should be warmed for no more than 15 minutes as many bacteria can grow rapidly in warm temperatures (6 to 47 °C). Caregivers should swirl the formula in the bottle and check the temperature on the inside of their wrist to prevent hotspots and to ensure that the formula is not too hot for the infant. Once warmed, the formula should be fed immediately. Any infant formula that is not consumed within two hours should be discarded. Leftovers should never be reheated, refrigerated or saved for next feed.

Reference: Safe preparation, storage and handling of powdered infant formula; World Health Organization; Year 2007