Caring for and Feeding Your Baby 《2》
Script
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00:00 - 02:13 Introduction
02:14 - 04:15 Responsive Feeding
04:16 - 08:32 Ensuring that the baby has enough milk: Output Monitoring
08:33 - 12:31 Breastmilk Production & Calibration
12:32 - 13:31 Let-down Reflex & Prelude
13:32 - 17:25 Common Breastfeeding Positions
17:26 - 19:19 Direct Breastfeeding & Nipple Preference
19:20 - 20:43 Healthy Eating during Breastfeeding
20:44 - 21:18 Combining Breastfeeding with Work
21:19 - 22:16 Health & Community Resources
22:17 - 24:05 Frequently Asked Questions
Welcome everyone to our online discussion about "Caring for and Feeding your Baby Discussion 2". When we refer to "caring for your baby", it means the practical baby care tips and information about infant feeding. We recommend you joining this discussion along with your family, such that everyone can learn more about baby care, and better prepare for when your baby arrives, in turn gaining confidence in looking after your baby. Today's content will be quite comprehensive. We will discuss how to feed your baby, what responsive feeding is, how to know your baby is getting enough milk, and how to monitor your baby's urinary and bowel output. We will also explore breastmilk production and calibration, common breastfeeding positions, so that after the baby is born, you will have a general idea of how to hold and position your baby during breastfeeding. Before we begin, let's do a little warm-up exercise together. Imagine your baby has just been born and you've brought them home…Have you thought of when to feed your baby? We once heard some mothers mention that they would strictly feed their baby every 3 to 4 hours. Have you ever wondered how much milk to give each time? Some say, "Feed according to the instructions on the milk powder cans." But does feeding a baby really need to be so rigid? Let's think about this: Do you eat at the same time every day? Do you eat exactly the same amount every meal? I believe most of us already know the answer. Just like adults, babies may not eat the same amount or eat at the same time every day. As we mentioned in the previous "Discussion 1", the best way to feed our babies is to respond to their early hunger cues.
We have briefly reviewed the key points from "Discussion 1". Are there more tips about feeding babies to share? We must share the concept of "Responsive Feeding". Whether you are directly breastfeeding or bottle feeding, we should respond to the baby's needs on when and how much to feed them. Even if your baby just fed an hour ago, if you see their mouth opening and rooting for food, it is likely that they are hungry again. On the other hand, perhaps your baby usually nurses for 15 minutes, but today, they stop after 10 minutes. Or when bottle feeding, your baby lets go of the teat. These are clear signs that they are full. We should never think: "It's not time yet, so don't feed too early." or "There's milk left in the bottle, they must finish it all." Babies may not eat the same amount or eat at the same time every day. Let's feed our baby when they show early hunger cues. They tend to be more cooperative and less likely to choke. At the same time, we need to learn to stop when there are signs of fullness. We should never force feed to complete the bottle. And, if you are directly breastfeeding, it does more than simply meeting the baby's nutritional needs. A mother may offer her breast when her baby needs closeness and comfort, for example: when they appear lonely, receive vaccines, or when they are unwell. Breastfeeding can help settle and soothe your baby. Have you ever considered that you may offer your breast for your own physical and emotional needs? For example: when your breasts feel full, before going out, or when you want to cuddle with your baby.
In fact, many mothers have shared that they often worry about whether their baby is getting enough milk, especially those are directly breastfeeding as they don't know how much milk the baby has taken. Some mothers even consider expressing breastmilk to check whether their baby is getting enough milk. What are your thoughts on this? Actually, there are reliable ways to tell whether your baby is getting enough milk. Pay attention to what I'm going to share. If your baby has taken enough milk, you can notice his contented look immediately after each meal as shown in the picture. Your baby will relax their body and sleep with hands open and loose. They will be satisfied and completely relaxed after a feed. In the long run, what else can you notice? You can measure your baby's weight to ensure a steady weight gain. At home, you can monitor your baby's soiled and wet nappies over the past 24 hours. We will discuss later how many soiled and wet nappies are considered sufficient. Whether breastfeeding or formula feeding, babies behave similar to adults. The more they eat, the more nappies they soil. The frequency and amount of soiled and wet nappies can reflect how well they eat. So, how many soiled and wet nappies are considered sufficient? Let us go through the "Feeding Journey" section of "Love, Starts from Breastfeeding" booklet. You can also revisit the content of "Love, Starts from Breastfeeding" later. Let's look at what happens on the first day after birth. On the first day, newborn babies are very tired after the delivery process, so they are sleepy. However, they still require feeds at least 3 to 4 times. They pass dark green and sticky meconium, with at least one wet nappy. From Day 2 to 4, be prepared for your baby to be more alert and require more frequent feeding. Commonly, babies become hungry an hour or so after being fed. Babies may always seem hungry. And some mothers may be stressed: "Why is my baby always hungry?" "Do I have enough breastmilk?" Moreover, most mothers and babies have gone home from hospitals and may not be able to seek help from nurses easily. Therefore, mothers should learn to see if their babies are fed enough. From Day 2 to 4, the size of a baby's stomach is about the size of a ping pong ball. Therefore, babies drink small amounts of milk each meal, but feed frequently. Whenever breastmilk is removed from the mother's breasts every 1 hour or so, mothers will produce more milk. If babies are taking enough milk, their meconium will change colour from dark brown to yellowish and have more wet nappies. By around Day 4, babies will produce at least 3 to 4 rather heavy nappies a day. By Day 5, you will likely be much more familiar with your baby and better at recognizing their early hunger cues. Babies generally feed at least 8 times within 24 hours. If they have taken enough milk, they will produce at least 5-6 heavy and wet nappies, along with at least 2 soiled nappies a day. You might wonder: what exactly counts as a heavy wet nappy? A heavy nappy is equivalent to around 3 tablespoons or 45ml of water in a dry nappy. I recommend that if you have spare nappies at home, you can try pouring this amount of water into one to feel its weight and compare it directly with your baby's used nappies. This simple exercise will give you an idea of whether your baby is getting enough milk. It's something you can easily prepare.
Your baby will change and grow day by day. On the left side of the "Feeding Journey", you can find the changes in the mother's body and breastmilk supply. These changes are coordinated to meet your baby's needs. Let us now look step-by-step at what happens to your body. From the early stages of pregnancy, through the second trimester, and continuing up to about 36 hours after delivery, your body has been preparing a very precious gift for your baby: colostrum. You may have heard that although the amount of colostrum is small, it is exceptionally rich in antibodies—hence its nickname, "golden colostrum." In addition, its thicker, more concentrated consistency is specifically designed to help your baby learn how to coordinate suckling and breathing. Therefore, colostrum is truly tailor-made for your baby's earliest needs. From Day 2 to 3 after birth, you may begin to notice a distinct feeling of breast fullness or engorgement as your milk supply increases. This change is primarily driven by hormonal shifts in your body. Although your breasts may become so engorged such that it hinders your baby's ability to latch, the swelling should gradually subside within 24 hours. To help your baby latch better during this period of breast fullness, you can start early and breastfeed your baby frequently. If the engorgement becomes very uncomfortable, you can apply a cold compress to your breasts after feeding and take painkillers. The "calibration period" typically occurs in the first 3-5 weeks after delivery. During this time, your milk supply adjusts to your baby's needs. I will explain this in more details later. Following the "calibration period" in the first 3-5 weeks, whether you are expressing milk with a pump or directly breastfeeding, milk production becomes steadier. Mothers experience less apparent sensation of breast fullness. This is not something to worry about, as long as you readily respond to your baby's needs and cues. This can also help avoid the risk of ductal narrowing or mastitis. Many mothers are concerned about whether their milk supply is sufficient. How can we tell if we are producing enough breastmilk? Have you ever wondered how much is actually considered "enough"? If a mother produces enough milk, her milk should match her baby's feeding needs. Therefore, "enough" breastmilk is not the same for every mother and baby. There is no need to compare yourself with other mother-baby dyads around you. Now that we understand what "enough" means, what are the methods to produce enough breastmilk? Does breastmilk supply depend on specific foods, nourishing soups, breast massage, or other similar methods? Actually no. So, what does it depend on? That's right, just as illustrated in the diagram. It requires the concerted efforts of both mother and baby. As mentioned earlier, after "milk comes in", mothers enter the "calibration period" in which the milk production calibrates according to the babies' needs. If your baby has effective suckling and frequent feeding, breastmilk will be removed quickly from the breasts. Then, the mother's body will receive a message that there is a high demand. So, her body will increase milk production to match the baby's needs. Therefore, effective suckling and frequent feeding are crucial for milk production. On the other hand, if breastmilk remains in the breasts for prolonged periods, the body begins to produce inhibitory substances (FIL) that signals the body to reduce milk production. Most people are familiar with frequent feeding. It means responding to your baby's early hunger cues. Feeding on demand both during the day and at night is extremely important. A mother has a higher level of milk-producing hormone (prolactin) at night, so night-time feeding is helpful in increasing your milk supply.
Now that we know how to produce enough breastmilk. The next question is: how can you ensure a good milk flow, so your baby can feed more effectively? This relies on the "milk ejection reflex" or "let-down reflex". A strong "let-down reflex" allows the milk stored in the tiny sacs within the breast glands to be squeezed into the main milk ducts and then ejected out through the nipple to the baby. How can we prompt and enhance this "let-down reflex"? Here are some effective ways: Mothers can perform the "Prelude" before directly breastfeeding or milk expression. For example, as shown in illustrations like these, gently massage your breasts, or apply a warm compress on your breast for less than 3 minutes. Back massages by your family members can also prompt the "let-down reflex". Skin-to-skin contact with your baby is one of the most powerful ways to strengthen this "let-down reflex".
Now let us move on to practical demonstration and introduce breastfeeding positions. We have a baby here. Take a look at his cues. He is licking his lips and opening his mouth. What does this mean? Yes—those are early hunger cues. It is time to feed him. Alright, let us try to hold the baby close. Today we have a mother joining us who needs to feed her baby. Let us observe how she is feeding. This mother is feeding very well. Can you see? Her chest is close to the baby's body, and the baby's head is supported securely on her forearm. This natural holding method is called the "Cradle hold". It is generally more suitable for babies who have already mastered the skills of latching and suckling. In addition, today I would like to introduce a breastfeeding position recommended for beginners that is especially suitable for newborn babies: "Transitional hold". Because newborns' head and neck are not strong enough and it is difficult for them to turn their heads to suitable positions, this holding method allows the mother to assist the baby in achieving a close breastfeeding position, and it is also easier for mother to manage. Now let us go through the "Transitional hold" step-by-step. Please pay close attention. Step 1: The mother first supports the baby's head and neck with her palm. As you can see, the palm is placed behind the baby's neck. Be careful not to press the fingers on the sides of the head, simply hold securely and safely. Step 2: Use the forearm to support the baby's whole body. You can see that both the upper and lower body are fully supported, with no sagging downward. The mother and baby are very close together. At the same time, the other hand is free to support the breast, making it easier to guide the baby into the ideal position for latching. Notice the hand's shape is forming a C-hold, avoid placing the hand too close to the nipple and areola. With this hand position, it should be easier to hold the baby close to correct position. Step 3: When you see that your baby's mouth is wide open, you can bring them to your breast. Let us watch this movement again. Bring the baby to the breast gently. Please observe carefully from another angle: guide the neck towards your breast and let your baby's nose level with and point towards the nipple. Once again, first support the baby's neck and whole body and use the left hand to support the breast, wait for the wide gape, along with the baby's nose pointing to the nipple, and then you can bring him to the breast. By now, everyone should have a general idea of how to perform the "Transitional hold". If you would like to prepare even more thoroughly, for example, to learn more breastfeeding positions, understand more clearly how to bring the baby to the breast, recognize whether the baby has achieved a good attachment, and distinguish effective sucking from non-effective sucking, I highly recommend you to read Chapter 4 of "Love, Starts from Breastfeeding". When the time comes, you can bring this book with you to the hospital. It contains a lot of helpful videos and practical information tailored to your needs. You are all well prepared. I hope that after your baby is born, you will continue to learn breastfeeding skills. This process requires a great deal of patience and persistence, but gradually, both you and your baby will improve together and become more confident. After the baby is born, do not hesitate to ask the nurses or other staff to observe how the baby is feeding.
Why is it important to master direct breastfeeding? What are the benefits? When a baby is directly breastfeeding, he can control the pace of feeding. Once satisfied, your baby should naturally release the breast and pull away. This helps to prevent overfeeding and reduce the risk of childhood obesity, diabetes, and other related conditions in the future. Direct breastfeeding also requires coordination of various oral muscles, joints, and the tongue working together. This effectively promotes the baby's oral muscle development, which is highly beneficial for future chewing and speech development. Research has shown that babies who are directly breastfed are less likely to develop protruding teeth (malocclusion). Even more importantly, the skin-to-skin contact during breastfeeding fosters a strong parent-child bonding and provides significant benefits for the baby's brain development. I have discussed with some mothers, and many have expressed the same concern: after using a bottle or pacifier, their baby becomes reluctant to latch on directly for breastfeeding. Has anyone else heard about this? Let me share some information with you. The sucking mechanism for a bottle or pacifier is quite different from for the suckling of the breast. When breastfeeding directly, the baby uses negative pressure to draw milk into their mouth. So, after using a bottle or pacifier, the baby may struggle to switch back to the breast and find direct latching more difficult. If, for any reason, direct breastfeeding is not possible right now, during the first month after birth, you can feed expressed breastmilk using a cup instead. Detailed instructions on how to do this safely and effectively can be found in the book "Love, Starts from Breastfeeding". The technique is illustrated in the image shown here.
What supplements should be taken during pregnancy? I believe that many people already have some understanding of this, but have you considered what foods or supplements you should consume when breastfeeding your baby? You may refer to the leaflet titled "Healthy Eating During Pregnancy and Breastfeeding". It provides a detailed explanation of where most nutrients can be obtained. If you are interested, you can scan the QR code or find the information via the provided link. In particular, I would like to remind everyone about iodine intake, as it is crucial for the growth and brain development of your current foetus and your baby after birth. Research has shown that the typical "Hong Kong-style diet" does not provide sufficient iodine for pregnant and lactating mothers. Therefore, it is important to ensure adequate daily iodine intake. How can you achieve this? After giving birth, if you continue to breastfeed, you should keep taking multivitamins and mineral supplement that contains iodine. Additionally, incorporate iodine-rich foods into your diet, as shown in the images such as seaweed, seafood, or iodised table salt. (On screen) There is also a leaflet on the right titled "Do you have adequate iodine?" You can scan the QR code there to access detailed information.
In Hong Kong, many mothers return to work after giving birth. If you would like to learn more about how to prepare for combining breastfeeding with work, for example, you can discuss with your colleagues or supervisor in advance, you can find out where you can express milk, where to store expressed breastmilk, or what other preparations are needed. This will enable you to be much better prepared when you return to work after maternity leave. I encourage everyone to make good use of these two information sheets to gain a deeper understanding.
After you give birth, your family will undoubtedly offer support and care, but friends, as well as other new mothers who are going through the same experience, can also provide valuable help and encouragement. In this "Breastfeeding Resources Bookmark", you can find additional resources. This bookmark contains the website address of our department, along with a QR code that links to a collection of videos on infant feeding and baby care. Next to it is the breastfeeding hotline number. Should you have any questions or uncertainties regarding breastfeeding, please feel free to call the hotline for assistance. Below are details of various community support groups and peer support networks. If you use Facebook or require further support, you may contact them. This bookmark also includes information about services and resources provided by other organisations. Additionally, there is an information leaflet entitled "Feeding your baby in the early days: what you need to know 2", which addresses common breastfeeding questions and concerns in a clear question-and-answer format.
We now come to the frequently asked questions section. The parents we meet at the health centres often have various concerns and questions, as caring for a baby is not an easy task. I would like to take this opportunity to introduce some practical information to everyone, this booklet titled "Happy Parenting 1". It contains useful guidance on caring for newborn babies, such as "Care of the Umbilical Cord" and important points to note regarding a "Safe Environment". Of course, many mothers also ask about bottle feeding or the use of other feeding equipment what precautions should be taken or what needs special attention. You may refer to the leaflet "Guide to Bottle Feeding". Whether you are breastfeeding directly or using a bottle, there may be times when additional support is needed. We should always observe the baby's cues. When your baby shows early hunger cues such as stirring and mouth opening, you should feed your baby. Continue until your baby lets go of the teat. This indicates fullness and you should stop feeding. When cleaning, sterilising and storing bottles and other feeding equipment, please follow the manufacturer's instructions carefully to ensure safety. If, for any reason, infant formula is required, remember that the water used to prepare it must be at least 70°C or above, in order to kill certain harmful bacteria which may be present in the non-sterile powdered infant formula. Remember to check the temperature before feeding the baby. A gentle reminder to everyone: when preparing formula, always follow the exact mixing ratio stated on the formula can. Do not arbitrarily dilute it or make it more concentrated. That brings us to the end of today's talk. Thank you all for your kind attention.