Questions & answers

One baby, endless questions

Being a mom is hard. Especially being a new one. Does the baby breathe at night? Is he eating too much? Should I clean his nose, reheat his food, wash his toys?

Don’t worry. We have got you covered. We asked the Slovene paediatrician Denis Baš, MD, to answer some of the most frequently asked questions about new born babies and infants.

Denis Baš, MD, is a specialist pediatrician who works with school and pre-school children in the children's day clinic at Kamnik Medical Centre. He performs ultrasound of baby hips, gives lectures for moms-to-be and is a big supporter of the rational use of antibiotics for children.

Spend less time researching and more time enjoying the happy moments motherhood brings.

Expressed milk

Protection

Solid food

Respiratory system

EXPRESSED MILK

How do I prepare baby milk if the babysometimes cannot be breastfed?

Breast milk is the preferred food for newborns for several reasons. Despite a vast amount of research,its composition is still not fully explained. Manufacturersare trying to make substitute milk composition closer to breast milk, but breastfeeding and breast milk remain gold standards for human newborns and infants. There are various circumstances in which mothers cannot breastfeed (babies born prematurely, breast abnormalities, return to to work etc). In these cases we recommendexpressing the milk by hand, or by means of manual or electric pumps. Once it has been expressed, breast milk must be stored.

Babies can be breastfed easily. When I try to squeeze my milk, only a small amount comes out. What am I doing wrong?

If you have already tried to squeeze milk but it is not enough, it does not mean that you do not have enough milk. The feeling during squeezing and manual expression are different from the feeling when your baby is suckling, so for squeezing milk you need exercise. For more relaxed and better efficiency you can try a variety of methods, such as expressing by hand, using a hand pump and electrical / double pump. To stimulate the formation of milk before squeezing, you can place hot pads on your breast while listeningto relaxing music and gently massaging the breasts.

How do I store the expressed milk properly?

To ensure your baby’s food is safe, store expressed milk properly until use, even when you cannot breastfeed. Before expressing,wash your hands and clean all the equipmentthat you use for this task in order to avoid bacterial contamination. Store the extracted milk in small pots (60-120 ml), big enough for single meals. On the container, write the date and time the milk was expressed, so that you knowwhen it needs to be used by.Expressed milk is safein a closed container for up to 6 hours at room temperature, in a refrigerator (4°C) for 3-5 days and in a freezer (-18°C) for up to 3 months. Once frozen milk is defrosted, it can be stored in the refrigerator for 24 hours, but never refrozen.

How do I prepare stored expressed milk before using it?

Stored expressedmilk must be heated properly before the baby drinks it. The best milk temperature for feeding the baby is 37°C. Check its heat by dropping a bit of milk on your wrist, where you usually measure your heart rate. Expressedmilk should not be heated at a temperature above 40°C, as nutrients are destroyed this way.

The best way to reheat the milk is to place the bottle under hot running water, or place it for some time in a pot containing hot water. You can also use a special heating device, which is intended for warming bottles. Once the bottle is heated, shake it gently. This will equalise the temperature of the content and, at the same time, mix the fat that is separated from the remaining liquid in stored milk.

Can breast milk be warmed up in a microwave?

Reheating breast milk in a microwave is not recommended because microwaves can destroy some of its beneficial properties and nutrients. It should also not be over heated or cooked. The easiest way to control the milk temperature is by steam - heating the milk or by immersing it in hot water, continuously checking its temperature on yourwrist.

How long do I have to heat the bottle of milk when placed in hot water?

When the bottle of milk is placed in hot water, it is usually necessary to wait about 15 minutes for the contents to be warmed up to the appropriate temperature for the baby’s feed. Milk temperature must be checked regularly on the wrist. During heating, the bottle must be shaken repeatedly to ensure its contents are heated evenly and that the fat is mixed with the remaining liquid.

PROTECTION

My child puts everything he can reach in his mouth. Do I have to stop him from doing this?

Parents are often worried because their small children put anything they lay their hands on into their mouths. In child development, using the mouth is an important stage in gainingexperience and exploring the world. With his/hermouth, a child discovers new stimuli in discovering shapes, textures or tastes. There is nothing wrong with this. Of course, it must be ensured that the objects are large enough, not sharp and made of safe materials. Parents also worry that the child will become infected in this way. In any case, it is advisable that objects handled daily by the child are occasionally thoroughly cleaned and disinfected. One of the procedures for this in a natural way is the use of heating. Specially designed steam sterilisers can be used to disinfect.

How should I clean children's toys?

Children are in daily contact with their favourite toys. Other children also play with them and often the toys end up on the ground or in someone’s mouth. They accompany children when they are eating or sleeping. They are particularly priceless when the child is ill. Therefore, it is important that toys are often cleaned.

Rubber toys are constant companions of the child's first steps in learning about the world. These toys are also often useful in relieving pain during the growthof the first tooth. Because these toys are often in contact with the child's mouth, it is important that they are cleaned regularly and properly. Wash them under hot water using washing up liquid and disinfect them occasionally in a steriliser.

You can wash plush and fabric toys in the washing machine. Use a hand washing program and do not use too much detergent. Use a disinfectant intended for washing children's clothes.

If toys cannot be washed with water, clean themfrom time to time with a disinfectant spray that doesn't need to be rinsed. Before using it, check whether the product may come into contact with small children.

SOLID FOOD

When can I begin to introduce my child to solid food?

The best time to introduce complementary (mixed) food to a baby who is still being breastfed is when the child is older than 4 months. Before this age, the introduction of mixed food must be absolutely discouraged, because the baby's digestive organs have not yet developed sufficiently. Research hasshown that it does not make any sense to wait too long and that it is necessary to begin introducing solid food before the age of6 months. Breast milk does not provide any more optimal coverage of the baby's increased demand for macro and micro nutrients (iron, zinc).

How should I go about introducing children to solid food?

At the beginning, when introducing solid food, parents should be particularly patient and persistent. During this time, mixed solid food represents a new experience; exploring is not the main source of food. It is important that the child gets used to different tastes, densities and textures of food. Traditionally, in our environment, we begin to introduce vegetable-meat-potato porridge first. Fruit and cereal grains are introduced some time later, because children prefer sweet taste and might refuse vegetables. Food must be introduced at an interval of one week. Thisway, children usuallyget used to new flavours easily. At the same time it is possible to notice ifchildren have problems with specific foods.

At the beginning they will eat less than one teaspoon of food, some of them just two to three, while others will eat more. It is all right. Food should be at room temperature or a little warmer.

From 10 months of age upwards (if he already has teeth) a child can be offered solid foods in addition to liquid and pureed foods. Meat, fish, vegetables and fruit do not need to be mashed or pureed anymore but just cut into small pieces.

What kind of porridges or purees should be introduced as solid foods first?

At the beginning, low allergenic food should be introduced: vegetables (courgettes, carrots, potatoes, cauliflower, wild cabbage), rice, corn flakes, meat (poultry, veal, colt, rabbit meat). Then we can proceed with fruit (apple, banana, pear). For the first baby food we can prepare a rice porridge that, due to its mild neutral taste, can be mixed with breast milk. When children get used to the feeding spoon, after a week, it is possible to continue with a mashed carrots or courgetteporridge, prepared as a separate vegetable puree or added in to rice and breast milk. At weekly intervals, new foods can be gradually introduced. It is better to introduce cereals containing gluten (wheat, oats), when the child is predominantly breastfed or fed with extracted breast milk, therefore between 4 and 6 months. This way, the possibility ofthe child developing coeliac disease (intolerance to gluten) is reduced.

What if the child doesn't like vegetable-based purees?

Patience and perseverance must be our primary consideration in the implementation of nutrition. Studies say that we have to offer a child a new flavor 7 to 11 times and that we should not give up if the child sprinkles porridge on us and on himself. When you offer your child the first spoonful of food, yet you do not know exactly what he thinks about the new taste. During the first attempt, most children initially tighten their lips and do not care about the importance of that particular food taste. Therefore proceed only when the child opens his/her mouth again. Be aware that at the time of the introduction of food nutrients the child still receives the essential part of them from his/her mum's milk or formula milk. Many parents give up after three attempts of food refusal, but perseverance will pay off.

How do I prepare my baby's first solid food?

The best thing to do is to use fresh seasonal vegetables and fruits but frozen vegetables may be also used. Vegetables are usually cooked in water or steamed. When cooking, do not use salt or spices. When the food is cooked, mix it until is soft or mash it into a thick porridge. Child development and growth need high quality fats, therefore it is recommended to add vegetable oil (canola, olive, corn ) to vegetable- cereal- and meat-based foods. A teaspoon of oil must be added to the porridge prepared for one meal portion (150-200 ml).

How do I prepare foods that my baby will love to eat?

In introducing the baby to solid food, the first and mostimportant thing is to choose the ingredientswisely to start with. For the first meals, choose flavors that are not too strong or too unusual. For vegetables select, for example, carrots, potatoes or courgettes, and for fruit an apple or a banana. Citrus fruits are probably too sour to start with. Itis also not advisable to prepare food with cow's milk until the baby is at least six months old.

Food porridges can be prepared in a kitchen blender or with a fork. The consistency must be dense and compact, but not liquid. Harder fruits and vegetables must be steamed first. Avoid adding sugar or salt and stronger taste spices. If you want to sweeten the porridgeslightly, add a teaspoon of apple or pear pulp. Add vegetable oil to give flavor to vegetable dishes.

What is the best food for babies?

In addition to food taste, we must ensure that the baby's food contains all the necessary nutrients. Here are some general guidelines for introducing foods:

Bread: after 10 months old
Cow's milk: a standalone drink after 1 year old, small quantities even previously (preparation of cereal porridge, mashed potatoes)
Gluten (wheat, wheat meal, rye, barley, oats, oat flakes, spelt, pasta): after 4 months together with breastfeeding
Eggs (yolk and white): after 6 months old
Sugar, salt: after 1 year old
Honey: after 1 year old
Fish: possible after 6 months old, as fresh as possible, young fish (e.g. mackerel, herring, sardines, salmon)
Seafood: after 1 year old

A child’s nutrition must be balanced and must include a lot of vegetables, fruits and cereals. Red meat is the most important source of iron for our body. Here are some foods that contain a lot of certain vitamins or minerals:

Vitamin A: carrots, kale, spinach
Vitamin D: fish oil, oily sea fish, egg whites (we recommend replacing it with preparations of 400 IU vitamin D per day)
Vitamin E: rapeseed, sunflower and corn oil, wheat sprouts, hazelnuts
Vitamin K: green vegetables
Vitamin B1: legumes, some fish, potatoes, oat flakes
Vitamin B2: milk, milk products, eggs
Vitamin C: fresh fruit (citrus fruits, gooseberries, blackcurrants), vegetables (peppers, broccoli, fennel, cabbage, spinach, tomato)

Which foods must be avoided when preparing a baby's meal?

When preparing a baby's food the above principles must be followed, depending on the age we introduce food of determined groups. Up to 1 year old, goat’s milk, sheep’s milk and honey must be avoided. Due to the hard consistency and the possibility that it may go down the throat in the wrong way, it is not recommended to offer the child nuts and peanuts up to the age of 5 years. Children may enjoy processed products that contain these ingredients. Raw or partially cooked eggs, additional salted or sweetened food, carbonated beverages and foods intended for adults (sauces, coffee, tea) must also be avoided. Soya milk is not advisable for children who are allergic to cow's milk, because they are often also allergic to soya.

My child doesn't want to eat. What can I do?

When introducing solid food, many parents encounter the problem when their child refuses to eat. At least it seems so to them. In reality, the child is making a good progress gaining weight and growing. Remember that your appetite is not constant and even you do not always eat the same amount of food. It can happen that the child simply refuses to open his/her mouth and doesn't want to eat prepared foods. Your imagination must now play an important role: pretend that the spoon is an airplane, tell stories or decorate the child's food in a funny way and thereby prepare him to eat cooked food. There is not a unique recipe. There are as many ways to make children eat as there are children. Above all, patience will pay off. Children's stubbornness associated with their pleasantness will often mean failure for their parents at the table battle.

Once your child is finally convinced that it is worth trying the new food once more, be innovative. Offer him/her fruit and vegetables, but in a disguised way. If the child doesn't like the "vegetable flavor", improve it adding grated cheese or a dressing made of butter and breadcrumbs. If he grimaces at the sight of fruits, mix them with milk or yoghurt and offer him an amusing baby cocktail.

There is also the possibility that children refuse to eat because they are simply not hungry. Children have a much better sense of hunger thanadults. A child’s stomach is only as big as a small fist andparents often overestimate how much food a child needs.

During the transition to solid food, my baby has becomeconstipatedwhen pooing. What can I do?

Food changes cause changes in bowel habits. Normally, the transition to solid foods establishes defecation every day. Some children may have transitional problems with a blocked poo. Most often the cause is due to too little fluid and fibre intake. Here are somesimple approaches:

Encourage your baby to move around.
With some movement exercises the digestive tract will accelerate its function.
Massage his/her belly and stimulate his/her peristalsis.
Make sure your child takes enough fluids (boiled cooled water between meals).
Offer him/her as many fruits and vegetables as possible (NO bananas, NO carrots).
Give him/her sweetened tea or dried prunes soaked in juice.
In the event that the problem persists, softening aids which do not cause dependence of the bowel are recommended. It is important that defecation does not cause pain or unpleasant cramps to the child. We advise against irritating his/her little bottom with a thermometer.

RESPIRATORY SYSTEM

How can I check if my child is breathing during the night?

The child's body slows down its functions at night, therefore it is sometimes very difficult to see if the child is breathing. There is a trick you can use, to be sure that everything is all right: dampen your index finger and place it just before the sleeping baby's nose. You will feel his/her breath like a slight breeze.

I have noticed that my child often coughs during the night. What can I do to make him/her sleep peacefully?

Coughing is a common companion of children. It is generally associated with respiratory viral infections, and, therefore, is very frequent in autumn and winter. First, we must ensure that the child can breathe through his/her nose and not through his/her mouth, because this will dry out the mucous membranes of the throat further, causing the cough to worsen. We must ensure that our child consumes enough fluids and that the placeswhere he/she sleeps are well ventilated. A relative humidity of between 40-60% is recommended in living spaces. Due to the heating, the air in our rooms is often too dry, causing the cough symptoms to get worse while skin and mucous membranes become drier. Therefore, it is advisable to maintain an adequate level of humidity. The trick that has been used since immemorial times, is to place wet towels or even containers with water on the radiator. Now, however, special devices are available - humidifiers - that promptly supply humidity and provide favorable conditions in the room.

How should I clean my baby's stuffy nose?

A frequent nuisance for small children is a stuffy and runny nose. The nose must be relieved from congestion to make the child happy, breathe better and eat. If the child has a stuffy nose or can't breathe through it properly, it is recommended to clean it with a saline solution or with a hypertonic saline solution. It is important that the solution is dripped or lightly sprayed into the nose and NOT injected with high pressure. If we inject the solution into the nose with heavy pressure, we'll push all the dirt into the tube that connects the ear to the nose area, which will increase the risk of ear infection. When a child does not know how to blow out the contents from his/her nose, these can be gently sucked out and the dried secretions, visible at the end of the nasal openings, can be removed by applying a gauze pad. To prevent a stuffy nose with dried nasal mucus, it is important to have the right degree of humidity in the room where the child is.

Winter is at the door. How can I keep my baby healthy?

In autumn and winter, we stay indoors longer. With favourable temperatures for viruses spreading, we are more under attack from pathogens of various infections. These viral infections can be especially hard for babies and young children who do not yet have a fortified immune system. In order to protect our little ones as much as possible against infections, we should keep in mind a few simple principles.

Anyway, it is wise to avoid areas with a large flow of people (shopping centres, playgrounds etc), especially in periods when there is a high probability that there are quite ill or contagious people in the crowd. Most viruses are transmitted through the air and many are spread by the touch of our hands. Therefore, it is important to wash hands, stay in the open air and avoid sick children. For newborns and babies, visits by children who are in collective institutes must be avoided.

Strengthen your immune system by eating a balanced diet, with plenty of fruits, vegetables and, if necessary, nutritional supplements (vitamin D). Physical activity as well as a sufficient amount of sleep strengthen our immune system cells.

Can a dummy harm my child?

Like every medal, using a dummy also has two sides. Above all, there is no evidence that children who suck dummies breastfeed for less time or less successfully. But it is known that children who used a dummy after 1 year old have more irregularities in forming their bite. However, the choice whether the child should have a dummy or not is up to the parents. If the child doesn't feel the need to have a dummy or doesn't want one, it should not be pushed into his/her mouth. The best thing to do is to not overdo it and offer the dummy to the child when he really needs it. After 1 year old, using a dummy is not recommended because of its impact on the development of the teeth. It is also important that the child takes the dummy out of his/her mouth when going to sleep. Dummies must be washed repeatedly and disinfected periodically, in order to remove all (in)visible impurities accumulated on them.