Formula Foods: 2014

Baby Food and Infant Formula

Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off infections. That's why extra care should be taken when handling and preparing their food and formula.

Baby Food

The most important action that you can take to prevent foodborne illness in your babies and children is to wash your hands. Your hands can pick up harmful bacteria from pets, raw foods (meat, poultry, seafood, eggs), soil, and diapers.
Always wash your hands:

Before and after handling food
After using the bathroom, changing diapers, or handling pets.

Other ways to keep your baby’s food safe:

Check the packaging of commercial baby food before serving: The following may indicate that the food is contaminated or at risk of bacterial contamination:
- For jars: Make sure that the safety button on the lid is down. Discard any jars that don’t “pop” when opened or that have chipped glass or rusty lids.
- For plastic pouches: Discard any packages that are swelling or leaking.
Don’t “double dip” with baby food: Never put baby food in the refrigerator if the baby doesn’t finish it. Your best bet: Don’t feed your baby directly from the jar of baby food. Instead, put a small serving of food on a clean dish and refrigerate the remaining food in the jar. If the baby needs more food, use a clean spoon to serve another portion. Throw away any food in the dish that’s not eaten. If you do feed a baby from a jar, always discard any remaining food.
Don’t share spoons: Don’t put the baby’s spoon in your mouth or anyone else’s mouth – or vice versa. If you want to demonstrate eating for your baby, get a separate serving dish and spoon for yourselv.
Never leave any open containers of liquid or pureed baby food out at room temperature for more than two hours: Harmful bacteria grows rapidly in food at room temperature.
Store opened baby food in the refrigerator for no more than three days: If you’re not sure that the food is safe, remember this saying: “If in doubt, throw it out.”

General Information on Baby Food

Once Baby Arrives: Food Safety for Moms-to-Be (FDA)
Do’s and don’ts for feeding your baby, plus tips on microwaving baby food and when to call the doctor.

Infant Formula

If you’re the parent or caretaker of an infant, you’ve probably heard that breast milk is the best source of nutrition for infants. In situations in which it’s not possible to breastfeed an infant, you may choose to use a commercially prepared infant formula.
Why can’t I give my baby cow’s milk?
Cow's milk by itself is not appropriate for infants less than 1 year old. Cow’s milk does not have the correct balance of nutrients for infants to grow and develop normally, and it can cause problems with anemia and kidney function.
Raw milk is never appropriate for infants – or anyone else. It should not be consumed by anyone at any time for any purpose. Raw milk can harbor dangerous microorganisms, such as Salmonella, E. coli, and Listeria, that can pose serious health risks.
But isn’t formula made from cow’s milk?
Most infant formula is made with cow's milk, but it has been modified and supplemented with additional nutrients. As a result, the formula is more nutritious and easier for the baby to digest than cow’s milk. Other formula options include soy-based formulas and hypoallergenic (or protein hydrolysate and amino acid-based) formulas. Special formulas are available for babies who are premature or have other health problems.
How does the government regulate infant formula?
The FDA does not approve infant formulas before they can be marketed. All formulas marketed in the United States, however, must meet Federal nutrient requirements. The FDA also monitors infant formula, which means that it inspects facilities that manufacture formula and analyzes samples.
What can I do to make sure that formula is safe for my baby?
Here are a few basic steps that you can follow to ensure that formula is safe from bacteria that can cause illness.

Prepare safe water for mixing: Bring tap water to a roiling boil and boil it for one minute. If you use bottled water, follow this same process unless the label indicates that it is sterile. Then, cool the water quickly to body temperature before mixing the formula.
Use clean bottles and nipples: You may want to sterilize bottles and nipples before first use. After that, it’s safe to wash them by hand or in a dishwasher.
Don't make more formula than you will need: Formula can become contaminated during preparation, and bacteria can multiply quickly if formula is improperly stored. Your best bet: prepare formula in smaller quantities on an as-needed basis to greatly reduce the possibility of contamination. And always follow the label instructions for mixing formula.

General Information on Infant Formula

Infant Formulas (NIH MedlinePlus)
Trusted information on types of formula, recommendations, and side effects of improper use.
FDA 101: Infant Formula (FDA)
The basics on types of formula, along with safety tips and instructions for reporting problems.
Safe Preparation, Storage and Handling of Powdered Infant Formula (World Health Organization)
Guidelines on infant formula in English, French, Spanish, Chinese, Russian, Arabic, and Japanese.

Diseases of the White Blood Cells

Neutropenia occurs when there aren't enough of a certain type of white blood cell to protect the body against bacterial infections. People who take certain chemotherapy drugs to treat cancer may develop neutropenia.
Human immunodeficiency virus (HIV) is a virus that attacks certain types of WBCs (lymphocytes) that work to fight infection. Infection with the virus can result in AIDS (acquired immunodeficiency syndrome), leaving the body prone to infections and certain other diseases. Newborns can become infected with the virus from their infected mothers while in the uterus, during birth, or from breastfeeding, although HIV infection of the fetus and newborn is usually preventable with proper medical treatment of the mother during pregnancy and delivery. Teens and adults can get HIV from sex with an infected person or from sharing contaminated needles used for injecting drugs or tattoo ink.
Leukemias are cancers of the cells that produce WBCs. These cancers include acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphocytic leukemia (ALL), and chronic lymphocytic leukemia (CLL). The most common types of leukemia affecting kids are ALL and AML. In the past 25 years, scientists have made great advances in treating several types of childhood leukemia, most notably certain types of ALL.

Diseases of Platelets

Thrombocytopenia, or a lower than normal number of platelets, is usually diagnosed because a person has abnormal bruising or bleeding. Thrombocytopenia can occur due to several different reasons when someone takes certain drugs or develops infections or leukemia or when the body uses up too many platelets. Idiopathic thrombocytopenic purpura (ITP) is a condition in which the immune system attacks and destroys platelets.

Diseases of the Clotting System

The body's clotting system depends on platelets as well as many clotting factors and other blood components. If a hereditary defect affects any of these components, a person can have a bleeding disorder. Common bleeding disorders include:

Hemophilia, an inherited condition that almost exclusively affects boys, involves a lack of particular clotting factors in the blood. People with severe hemophilia are at risk for excessive bleeding and bruising after dental work, surgery, and trauma. They may experience episodes of life-threatening internal bleeding, even if they haven't been injured.
von Willebrand disease, the most common hereditary bleeding disorder, also involves a clotting-factor deficiency. It affects both males and females.

Other causes of clotting problems include chronic liver disease (clotting factors are produced in the liver) and vitamin K deficiency (the vitamin is necessary for the production of certain clotting factors).

Reviewed by: Yamini Durani, MD
Date reviewed: October 2012

Diseases of Red Blood Cells

Most of the time, blood functions without problems, but sometimes, blood disorders or diseases can cause illness. Diseases of the blood that commonly affect kids can involve any or all of the three types of blood cells. Other types of blood diseases affect the proteins and chemicals in the plasma that are responsible for clotting.
The most common condition affecting RBCs is anemia, a lower-than-normal number of red cells in the blood. Anemia is accompanied by a decrease in the amount of hemoglobin. The symptoms of anemia — such as pale skin, weakness, a fast heart rate, and poor growth in infants and children — happen because of the blood's reduced capacity for carrying oxygen.
Anemia typically is caused by either inadequate RBC production or unusually rapid RBC destruction. In severe cases of chronic anemia, or when a large amount of blood is lost, someone may need a transfusion of RBCs or whole blood.
Anemia resulting from inadequate RBC production. Conditions that can cause a reduced production of red blood cells include:

Iron deficiency anemia. The most common type of anemia, it affects kids and teens of any age who have a diet low in iron or who've lost a lot of RBCs (and the iron they contain) through bleeding. Premature babies, infants with poor nutrition, menstruating teenage girls, and those with ongoing blood loss due to illnesses such as inflammatory bowel disease are especially likely to have iron deficiency anemia.
Lead poisoning. When lead enters the body, most of it goes into RBCs where it can interfere with the production of hemoglobin. This can result in anemia. Lead poisoning can also affect — and sometimes permanently damage — other body tissues, including the brain and nervous system. Although lead poisoning is much less common now, it still is a problem in many larger cities, especially where young children might ingest paint chips or the dust that comes from lead-containing paints peeling off the walls in older buildings.
Anemia due to chronic disease. Kids with chronic diseases (such as cancer or human immunodeficiency virus infection) often develop anemia as a complication of their illness.
Anemia due to kidney disease. The kidneys produce erythropoietin, a hormone that stimulates production of red cells in the bone marrow. Kidney disease can interfere with the production of this hormone.
Anemia resulting from unusually rapid red blood cell destruction. When RBCs are destroyed more quickly than normal by disease (a process called hemolysis), the bone marrow will make up for it by increasing production of new red cells to take their place. But if RBCs are destroyed faster than they can be replaced, a person will develop anemia.

Several causes of increased red blood cell destruction can affect kids:

G6PD deficiency. G6PD is an enzyme that helps to protect red blood cells from the destructive effects of certain chemicals found in foods and medications. When the enzyme is deficient, these chemicals can cause red cells to hemolyze, or burst. G6PD deficiency is a common hereditary disease among people of African, Mediterranean, and Southeast Asian descent.
Hereditary spherocytosis is an inherited condition in which RBCs are misshapen (like tiny spheres, instead of disks) and especially fragile because of a genetic problem with a protein in the structure of the red blood cell. This fragility causes the cells to be easily destroyed.
Autoimmune hemolytic anemia. Sometimes — because of disease or for no known reason — the body's immune system mistakenly attacks and destroys RBCs.
Sickle cell disease, most common in people of African descent, is a hereditary disease that results in the production of abnormal hemoglobin. The RBCs become sickle shaped, they cannot carry oxygen adequately, and they are easily destroyed. The sickle-shaped blood cells also tend to abnormally stick together, causing obstruction of blood vessels. This blockage in the blood vessels can seriously damage organs and cause bouts of severe pain.

Platelets

Platelets (also called thrombocytes) are tiny oval-shaped cells made in the bone marrow. They help in the clotting process. When a blood vessel breaks, platelets gather in the area and help seal off the leak. Platelets survive only about 9 days in the bloodstream and are constantly being replaced by new cells.
Important proteins called clotting factors are critical to the clotting process. Although platelets alone can plug small blood vessel leaks and temporarily stop or slow bleeding, the action of clotting factors is needed to produce a strong, stable clot.
Platelets and clotting factors work together to form solid lumps (called blood clots) to seal leaks, wounds, cuts, and scratches and to prevent bleeding inside and on the surfaces of our bodies. The process of clotting is like a puzzle with interlocking parts. When the last part is in place, the clot happens — but if even one piece is missing, the final pieces can't come together.
When large blood vessels are severed (or cut), the body may not be able to repair itself through clotting alone. In these cases, dressings or stitches are used to help control bleeding.

Nutrients in the Blood

Blood contains other important substances, such as nutrients from food that has been processed by the digestive system. Blood also carries hormones released by the endocrine glands and carries them to the body parts that need them.
Blood is essential for good health because the body depends on a steady supply of fuel and oxygen to reach its billions of cells. Even the heart couldn't survive without blood flowing through the vessels that bring nourishment to its muscular walls.
Blood also carries carbon dioxide and other waste materials to the lungs, kidneys, and digestive system to be removed from the body.

Blood cells and some of the special proteins blood contains can be replaced or supplemented by giving a person blood from someone else via a transfusion. In addition to receiving whole-blood transfusions, people can also receive transfusions of a particular component of blood, such as platelets, RBCs, or a clotting factor. When someone donates blood, the whole blood can be separated into its different parts to be used in this way.

Red Blood Cells

Red blood cells (also called erythrocytes) are shaped like slightly indented, flattened disks. RBCs contain the iron-rich protein hemoglobin. Blood gets its bright red color when hemoglobin picks up oxygen in the lungs. As the blood travels through the body, the hemoglobin releases oxygen to the tissues.
The body contains more RBCs than any other type of cell, and each has a life span of about 4 months. Each day, the body produces new RBCs to replace those that die or are lost from the body.

White Blood Cells

White blood cells (also called leukocytes) are a key part of the body's system for defending itself against infection. They can move in and out of the bloodstream to reach affected tissues. Blood contains far fewer WBCs than red blood cells, although the body can increase WBC production to fight infection. There are several types of WBCs, and their life spans vary from a few days to months. New cells are constantly being formed in the bone marrow.
Several different parts of blood are involved in fighting infection. White blood cells called granulocytes and lymphocytes travel along the walls of blood vessels. They fight germs such as bacteria and viruses and may also attempt to destroy cells that have become infected or have changed into cancer cells.
Certain types of WBCs produce antibodies, which are special proteins that recognize foreign materials and help the body destroy or neutralize them. The white blood cell count (the number of cells in a given amount of blood) in someone with an infection often is higher than usual because more WBCs are being produced or are entering the bloodstream to battle the infection.

After the body has been challenged by some infections, lymphocytes "remember" how to make the specific antibodies that will quickly attack the same germ if it enters the body again in the future.

Blood Basics

Humans can't live without blood. Without blood, the body's organs couldn't get the oxygen and nutrients they need to survive, we couldn't keep warm or cool off, fight infections, or get rid of our own waste products. Without enough blood, we'd weaken and die.
Here are the basics about the mysterious, life-sustaining fluid called blood.

Blood Basics

Two types of blood vessels carry blood throughout our bodies:

Arteries carry oxygenated blood (blood that has received oxygen from the lungs) from the heart to the rest of the body.
Blood then travels through veins back to the heart and lungs, where it receives more oxygen.

As the heart beats, you can feel blood traveling through the body at pulse points — like the neck and the wrist — where large, blood-filled arteries run close to the surface of the skin.
The blood that flows through this network of veins and arteries is whole blood, which contains three types of blood cells:

red blood cells (RBCs)
white blood cells (WBCs)
platelets

In babies and young kids, blood cells are made within the bone marrow (the soft tissue inside of bones), particularly in the long bones like the humerus (the upper arm bone) and femur (the thigh bone). But, as kids get older and approach adulthood, blood cells are made mostly in the bone marrow of the vertebrae (the bones of the spine), ribs, pelvis, skull, sternum (the breastbone).

The cells travel through the circulatory system suspended in a yellowish fluid called plasma, which is 90% water and contains nutrients, proteins, hormones, and waste products. Whole blood is a mixture of blood cells and plasma.

Formula Feeding Challenges

As with breastfeeding, there are some challenges to consider when deciding whether to formula feed.
Organization and preparation. Prepare your baby's formula by mixing water and the appropriate amount of powdered infant formula. The packaging on the side of the formula container will tell you how much to use. Carefully follow the directions. You can use tepid (room temperature) tap water, as long as your local or state health departments have labeled it as safe to drink.
If you're concerned about your water, you may sterilize it to kill germs. Here's how:

pour cold tap water into a teapot or sauce pan
place pot on the stove over medium heat
bring water to a rolling boil and let boil for about a minute
let the water cool until it's at room temperature

Test to see if the water is cool enough for your baby to drink by shaking a few drops of water on the inside of your wrist. If it stings, it's still too hot. Once water has cooled, don't let it sit longer than 30 minutes before adding it to the formula.
Once prepared, the formula is ready to feed to your baby immediately without additional refrigeration or warming. Formula that's been prepared should be consumed or stored in the refrigerator within 1 hour. If it has been at room temperature for more than 1 hour, throw it away. And if your baby doesn't drink all the formula in the bottle, throw away the unused portion — never save it for later.
Formula may be prepared ahead of time (for up to 24 hours) if you store it in the refrigerator to prevent the formation of bacteria. Open containers of ready-made formula, concentrated formula, and formula prepared from concentrate also can be stored safely in the refrigerator for up to 48 hours.
Lack of antibodies. None of the antibodies found in breast milk are found in manufactured formula, which means that formula doesn't provide the baby with the added protection against infection and illness that breast milk does.
Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (i.e., soy and hypoallergenic) cost more — sometimes far more — than the basic formulas. During the first year of life, the cost of basic formula can run about $1,500.
Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.
Can't match the complexity of breast milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby's needs change.
Whatever nutritional option you choose, be sure to talk to your doctor about the choices available to help you make the decision that's best for both you and your baby.

About Formula Feeding

Breastfeeding is considered the best nutritional option for babies by the major medical organizations, but it's not right for every mother. Commercially prepared infant formulas are a nutritious alternative to breast milk, and even contain some vitamins and nutrients that breastfed babies need to get from supplements.
Manufactured under sterile conditions, commercial formulas attempt to duplicate mother's milk using a complex combination of proteins, sugars, fats, and vitamins that would be virtually impossible to create at home. So, if you don't breastfeed your baby, it's important that you use only a commercially prepared formula and that you do not try to create your own.
In addition to medical concerns that may prevent breastfeeding, for some women, breastfeeding may be too difficult or stressful.
Here are a few other reasons women may choose to formula feed:
Convenience. Either parent (or another caregiver) can feed the baby a bottle at any time (although this is also true for women who pump their breast milk). This allows the mother to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it.
Flexibility. Once the bottles are made, a formula-feeding mother can leave her baby with a partner or caregiver and know that her little one's feedings are taken care of. There's no need to pump or to schedule work or other obligations and activities around the baby's feeding schedule. And formula-feeding moms don't need to find a private place to nurse in public. However, if mom is out and about with baby, she will need to bring supplies for making bottles.
Time and frequency of feedings. Because formula is less digestible than breast milk, formula-fed babies usually need to eat less often than do breastfed babies.
Diet. Women who opt to formula feed don't have to worry about the things they eat or drink that could affect their babies.

Breastfeeding Challenges

Although it is the best feeding choice for babies and mothers, breastfeeding does come with some concerns that new mothers may share. Whereas it's easy from the get-go for some, it can be challenging. Sometimes, both mother and baby need plenty of patience and persistence to get used to the routine of breastfeeding. But all the effort is worth it in the long run — for both the mother and her baby.
Common concerns of new moms, especially during the first few weeks and months, may include:
Personal comfort. Initially, as with any new skill, many moms feel uncomfortable with breastfeeding. But with adequate education, support, and practice, most moms overcome this. The bottom line is that breastfeeding shouldn't hurt if the mother receives help and guidance.
Latch-on pain is normal for the first week to 10 days, and should last less than a minute with each feeding. But if breastfeeding hurts throughout feedings, or if the nipples and/or breasts are sore, it's a good idea for breastfeeding mothers to seek the help of a lactation consultant or their doctor. Many times, it's just a matter of using the proper technique, but sometimes pain can mean that something else is going on, like an infection.
Time and frequency of feedings. There's no question that breastfeeding does require a substantial time commitment from mothers. Then again, many worthwhile things in parenting do. Some women may be concerned that nursing will make it hard for them to work, run errands, or travel because of a breastfeeding schedule or a need to pump breast milk during the day. Many of these concerns can be addressed at a prenatal lactation consultant visit.
And breastfed babies do need to eat more often than babies who are fed formula, because breast milk digests faster than formula. This means mom may find herself in demand every 2 or 3 hours (maybe more, maybe less) in the first few weeks.
This can be tiring, but once breastfeeding has been established (usually in about a month), other family members may be able to help out by giving the baby pumped breast milk if mom needs a break or is going back to work outside the home. And it's not long before babies feed less frequently and sleep through the night (usually around 3 months). Also, with a little organization and time management, it becomes easier to work out a schedule to breastfeed and/or pump.
Diet. Women who are breastfeeding need to be aware of what they eat and drink, since things can be passed to the baby through the breast milk. Just like during pregnancy, breastfeeding women should avoid fish that are high in mercury, and limit lower mercury fish intake. If a woman has alcohol, a small amount can be passed to the baby through breast milk. She should wait to breastfeed at least 2 hours after a single alcoholic drink in order to avoid passing any alcohol to the baby. Caffeine intake should be kept to no more than 300 milligrams (about one to three cups of regular coffee) per day for breastfeeding women because it may cause problems such as restlessness and irritability in some babies. Some infants are sensitive enough to caffeine to have problems even with smaller amounts of caffeine. Discuss these situations with your health care provider or lactation consultant.
Maternal medical conditions, medicines, and breast surgery. Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medications may make breastfeeding unsafe. A woman should check with her doctor or a lactation consultant if she's unsure if she should breastfeed with a specific condition. Women should always check with the doctor about the safety of taking medications while breastfeeding, including over-the-counter and herbal medicines.
Mothers who've had breast surgery, such as a reduction, may have difficulty with supply if their milk ducts have been severed. In this situation, a woman should to talk to her doctor about her concerns and work with a lactation specialist.

About Breastfeeding

Nursing is a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many nursing mothers cherish.
Here are some of the many benefits of breastfeeding:
Infection-fighting. Antibodies passed from a nursing mother to her baby can help lower the occurrence of many conditions, including:

ear infections
diarrhea
respiratory infections
meningitis

Other factors help to protect a breastfed baby from infection by contributing to the infant's immune system by increasing the barriers to infection and decreasing the growth of organisms like bacteria and viruses.
Breastfeeding is particularly beneficial for premature babies and also may protect children against:

As a group, breastfed babies have fewer infections and hospitalizations than formula-fed infants.
Nutrition and ease of digestion. Often called the "perfect food" for a human baby's digestive system, breast milk's components — lactose, protein (whey and casein), and fat — are easily digested by a newborn's immature system.
As a group, breastfed infants have less difficulty with digestion than do formula-fed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer incidences of diarrhea or constipation.
Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. A healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D. Breast milk does contain some vitamin D, and vitamin D is produced by the body when the skin is exposed to sunlight. However, sun exposure increases the risk of skin damage, so parents are advised to minimize exposure. As a result, the AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until the infant consumes enough vitamin D-fortified formula or milk (after 1 year of age).
The U.S. Food and Drug Administration (FDA) regulates formula companies to try to ensure they provide all the known necessary nutrients (including vitamin D) in their formulas. Commercial formulas try to duplicate the ingredients in breast milk, but haven't matched their exact combination and composition. Why? Because milk is a living substance made by each mother for her individual infant, a process that cannot be duplicated in a factory.
Free. Breast milk doesn't cost a cent, while the cost of formula quickly adds up. And because of the immunities and antibodies passed onto them through their mothers' breast milk, breastfed infants are sick less often than infants who receive formula. For example, researchers have determined that infants who are breastfed exclusively have fewer episodes of ear infections. That may mean they make fewer trips to the doctor's office, which equates to fewer co-pays and less money doled out for prescriptions and over-the-counter medications.
Likewise, women who breastfeed are less likely to have to take time off from work to care for their sick babies.
Different tastes. A nursing mother will usually need 500 extra calories per day, which means that she should eat a wide variety of well-balanced foods. This introduces breastfed babies to different tastes through their mothers' breast milk, which has different flavors depending on what their mothers have eaten. By tasting the foods of their "culture," breastfed infants more easily accept solid foods.
Convenience. With no last-minute runs to the store for more formula, breast milk is always fresh and available. And when women breastfeed, there's no need to warm up bottles in the middle of the night. It's also easy for breastfeeding mothers to be active — and go out and about — with their babies and know that they'll have food available for whenever their little one is hungry.
Obesity prevention. Some studies have found that breastfeeding may help protect a child from obesity.
Smarter babies. Some studies suggest that children who were exclusively breastfed have slightly higher IQs than children who were formula fed.
"Skin-to-skin" contact. Many nursing mothers really enjoy the experience of bonding so closely with their babies. And the skin-to-skin contact can enhance the emotional connection between mother and infant.
Beneficial for mom, too. The ability to nourish a baby totally can also help a new mother feel confident in her ability to care for her baby. Breastfeeding also burns calories and helps shrink the uterus, so nursing moms may be able to return to their pre-pregnancy shape and weight quicker. In addition, studies show that breastfeeding helps lower the risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer. In one long-term study of the National Institutes of Health Women’s Health Initiative, women who breastfed for at least 7 to 12 months after giving birth had a lower risk of cardiovascular disease.

Breast or Bottle?

Choosing whether to breastfeed or formula feed your baby is one of the first decisions expectant parents will make. The American Academy of Pediatrics (AAP) joins other organizations such as the American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) in recommending breastfeeding as the best for babies. Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions.
The AAP says babies should be breastfed exclusively for the first 6 months. Beyond that, the AAP encourages breastfeeding until at least 12 months, and longer if both the mother and baby are willing.
Although experts believe breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many women, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical considerations that they might have.
For mothers who are unable to breastfeed or who decide not to, infant formula is the alternative. Some women feel guilty if they don't breastfeed. You'll still bond with your baby just fine. After all, whether with breast milk or formula, feeding is an important time of connection between mother and baby.

The decision to breastfeed or formula feed your baby is a very personal one. But here are some points you may want to consider as you decide which is best for you and your new addition.

Lightening Your Load

The stress involved in caring for a child with a long-term illness is considerable, but these tips might ease the strain:

Break problems into manageable parts. If your child's treatment is expected to be given over an extended time, view it in more manageable time blocks. Planning a week or a month at a time may be less overwhelming.
Attend to your own needs. Get appropriate rest and food. To the extent possible, pay attention to your relationship with your spouse, hobbies, and friendships.
Depend on friends. Let them carpool siblings to soccer or theater practice. Permit others — relatives, friends — to share responsibilities of caring for your child. Remember that you can't do it all.
Ask for help in managing the financial aspects of your child's illness.
Recognize that everyone handles stress differently. If you and your spouse have distinct coping styles, talk about them and try to accommodate them. Don't pretend that they don't exist.
Develop collaborative working relationships with health care professionals. Realize you are all part of the team. Ask questions and learn all you can about your child's illness.
Consult other parents in support groups at your care center or hospital. They can offer information and understanding.
Explore support groups for parents who have children with the same or similar illness.
Keep a journal.
Utilize support staff offered at the treating hospital.

Reviewed by: Dale Perkel, LCSW
Date reviewed: January 2012

Behavioral Issues

Kids with chronic illnesses certainly require extra "tender loving care", but also need the routines of childhood. The foremost — and perhaps trickiest — task for worried parents is to treat a sick child as normally as possible.
Despite the circumstances, this means setting limits on unacceptable behavior, sticking to normal routines, and avoiding overindulgence. This may seem impossible, particularly if you have feelings of guilt or an intense need to protect your sick child. But spoiling or coddling can only make it harder for a child to return to daily activities. When your child leaves the hospital for home, normalcy is the goal.

Dealing With Siblings

Family dynamics can be severely tested when a child is sick. Clinic visits, surgical procedures, and frequent checkups can throw big kinks into everyone's schedules and take an emotional toll on the entire family.
To ease the pressure, seek help to keep the family routines as close to normal as possible. Friends and family members may be able to help handle errands, carpools, and meals. Siblings should continue to attend school and their usual recreational activities; the family should strive for normalcy and time for everyone to be together.
Flexibility is key. The "old normal" may have been the entire family around the table for a home-cooked meal at 6:00, while the "new normal" may be takeout pizza on clinic nights.
Also, consider talking with your other children's teachers or school counselors and let them know that a sibling in the family is ill. They can keep an eye out for behavioral changes or signs of stress among your kids.
It's common for siblings of a chronically ill child to become angry, sullen, resentful, fearful, or withdrawn. They may pick fights or fall behind in schoolwork. In all cases, parents should pay close attention, so that they don't feel pushed aside by the demands of their sick brother or sister.
It may also help them to be included in the treatment process when possible. Depending on their ages and maturity level, visiting the hospital, meeting the nursing and physician staffs, or accompanying their sick sibling to the clinic for treatments can also help make the situation less frightening and more understandable for the healthy siblings.

What they imagine about the illness and hospital visits are often worse than the reality. When they come to the hospital, they can develop a more realistic picture and see that, while unpleasant things may be part of the treatment, there are people who care about their sibling and do their best to help.

Tackling Tough Emotions

Your child will have many feelings about the changes affecting his or her body, and should be encouraged and given opportunities to express any feelings, concerns, and fears. Ask what your child is experiencing and listen to the answers before bringing up your own feelings or explanations.
This kind of communication doesn't always have to be verbal. Music, drawing, or writing can often help kids living with a life-threatening disease express their emotions and escape through a fantasy world of their own design.
Kids may also need reminders that they're not responsible for the illness. It's common for them to fear that they brought their sickness on by something they thought, said, or did. Reassure your child that this is not the case, and explain in simple terms what caused the illness. (You may also want to reassure your other kids that nothing they said or did caused their sibling's illness.)
For many questions, there won't be easy answers. And you can't always promise that everything is going to be fine. But you can help your child feel better by listening, saying it's OK and completely understandable to have those feelings, and explaining that you and your family will make him or her as comfortable as possible.
If a child asks "why me?" it's OK to offer an honest "I don't know." Explain that even though no one knows why the illness occurred, the doctors do have treatments for it (if that's the case). If your child says "it's not fair that I'm sick," acknowledge that your child is right. It's important for kids to know it's OK to feel angry about the illness.
Your child may ask "am I going to die?" How you answer will depend on your child's age and maturity level. It's important to know, if possible, what specific fears or concerns your child has and to address them specifically.
If it is reassuring to your child, you may refer to your religious, spiritual, and cultural beliefs about death. You might want to stay away from euphemisms for death such as "going to sleep." Saying that may cause children to fear going to bed at night.
Regardless of their age, it's important for kids to know that there are people who love them and will be there for them, and that they'll be kept comfortable.

Just like any adult, a child will need time to adjust to the diagnosis and the physical changes and is likely to feel sad, depressed, angry, afraid, or even to deny that they are sick. Think about getting professional counseling if you see signs that these feelings are interfering with daily function, or your child seems withdrawn, depressed, and shows radical changes in eating and sleeping habits unrelated to the physical illness.

Explaining Long-Term Illness to a Child

Taking care of a chronically ill child is one of the most draining and difficult tasks a parent can face. Beyond handling physical challenges and medical needs, you'll have to deal with the emotional needs your child may have and the emotional impact that the prolonged illness can have on the entire family.
Luckily, this tough balancing act doesn't have to be done alone: support groups, social workers, and family friends often can lend a helping hand.

Explaining Long-Term Illness to a Child

Honest communication is crucial to helping a child adjust to a serious medical condition. It's important for a child to know that he or she is sick and will be getting lots of care. The hospital and the medicine may feel frightening, but they're part of helping your child feel better.
As you explain the illness and its treatment, give clear and honest answers to all questions in a way your child can understand. It's also important to accurately explain and prepare your child for any treatments — and possible discomfort that might go with along with those treatments.
Avoid saying "This won't hurt" if the procedure is likely to be painful. Instead, be honest if a procedure may cause some discomfort, pain, pressure, or stinging, but then reassure your child that it will be temporary and that you'll be there to offer support while or after it's done.

Many hospitals give parents the option to speak to their child about a long-term diagnosis alone, or with the doctor or the entire medical team (doctors, social workers, nurses, etc.) present. Your doctor or other medical professional probably can offer advice on how to talk to your child about the illness.