Slide show: Breast-feeding positions

Breast-feeding: Cross-cradle hold

Breast-feeding can be awkward at first. Experiment with various positions until you feel comfortable.

The cross-cradle hold is ideal for early breast-feeding. Sit up straight in a comfortable chair with armrests. Hold your baby crosswise in the crook of the arm opposite the breast you're feeding from — left arm for right breast, right arm for left. Support the baby's trunk and head with your forearm and palm. Place your other hand beneath your breast in a U-shaped hold to guide the baby's mouth to your breast. Don't bend over or lean forward. Instead, cradle your baby close to your breast.

Breast-feeding: Cradle hold

The cradle hold is similar to the cross-cradle hold, but you support the baby with the arm on the same side as the nursing breast, rather than the opposite arm. As with the cross-cradle hold, sit up straight — preferably in a chair with armrests. Cradle your baby and rest his or her head in the crook of your elbow while he or she faces your breast. For extra support, place a pillow on your lap.

Breast-feeding: Football hold

Another option is the football hold. This position may be a good choice if you're recovering from a C-section, you have large breasts or you're nursing two babies at once.

Hold your baby at your side, with your elbow bent. With your open hand, support your baby's head and face him or her toward your breast. Your baby's back will rest on your forearm. It may help to support your breast in a C-shaped hold with your other hand. For comfort, put a pillow on your lap and use a chair with broad, low arms.

Breast-feeding: Side-lying hold

A lying position may help your baby latch onto your breast correctly in the early days of breast-feeding, especially after a C-section. It's also a good choice when you're tired.

Lie on your side and face your baby toward your breast, supporting him or her with the hand of the arm you're resting on. With your other arm and hand, grasp your breast and then touch your nipple to your baby's lips. Once your baby latches on, use the bottom arm to support your own head and your top hand and arm to help support the baby.

Circumcision for baby boys: Weighing the pros and cons

If you have a baby boy, you'll need to decide whether to have him circumcised. Consider the pros and cons.

Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common in certain parts of the world, including the United States and Canada. But is it right for your son? Here's help making an informed decision.

Opinions are mixed
For some parents, circumcision is a religious ritual. It can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, the procedure seems unnecessary or disfiguring.

In 1999, the American Academy of Pediatrics (AAP) issued a policy statement that says the benefits aren't strong enough to recommend routine circumcision for all male newborns. Today, the AAP leaves the decision up to parents — and supports use of pain relief for infants who have the procedure.

The benefits
Circumcision may have health benefits, including:

• Easier hygiene. Circumcision makes it easy to wash the penis — although it's simple to clean an uncircumcised penis, too.
• Decreased risk of urinary tract infections. The risk of urinary tract infections in the first year is low, but these infections may be up to 10 times as common in uncircumcised baby boys. Severe infections early in life can lead to kidney problems later on.
• Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may be difficult or impossible to retract (phimosis). This can also lead to inflammation of the head of the penis.

The drawbacks
Circumcision also has drawbacks, including:

• Surgical risks. Excessive bleeding and infection are uncommon, but possible. The foreskin may be cut too short or too long or fail to heal properly. If the remaining foreskin reattaches to the end of the penis, minor surgery may be needed to correct it.
• Pain. Circumcision hurts. Local anesthesia can block nerve sensations during the procedure.

Other considerations
Circumcision may not be an option if your son has certain medical conditions, such as an abnormality of the penis that requires surgical treatment. In this case, the foreskin may be needed for repair. Circumcision doesn't affect fertility, nor is circumcision thought to enhance or detract from sexual pleasure for men or their partners. After a circumcision, it may be impossible to re-create the appearance of an uncircumcised penis.

The procedure
Circumcision is often done in the hospital nursery. It may also be done in an outpatient setting within the first few weeks after birth. Your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis or applied to the penis as a cream. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed. Afterward, the penis will be covered with an ointment, such as petroleum jelly, and wrapped loosely with gauze.

The procedure takes about five to 10 minutes.
Circumcision care
It usually takes about seven to 10 days for the penis to heal. The tip of the penis may seem raw at first, and you may notice a yellowish mucus or crust. A small amount of bleeding also is common the first day or two.

It's OK to wash your son's penis as it's healing. Change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. If there's a plastic ring instead of a bandage, it will drop off on its own — usually within a week. Once your son's penis heals, wash it with soap and water during each bath.

Problems after circumcision are rare. Contact your son's doctor if:
* Your son doesn't urinate normally within six to eight hours after the circumcision
* There's persistent bleeding or redness around the tip of the penis
* There's foul-smelling drainage from the tip of the penis or crusted sores fill with fluid

If you skip the circumcision
If you choose not to have your son circumcised, simply wash your son's penis with soap and water during each bath. There's no need to clean beneath the foreskin until it retracts on its own, often by age 5. Then teach your son to clean beneath the foreskin during each bath — gently pull back the foreskin, clean the area with soap and water, rinse and pull the foreskin back over the head of the penis. After each bath, pull back the foreskin again to dry the area.

Babies and solid foods: What to serve when

Most babies are ready for solid foods between ages 4 months and 6 months. Here's when — and how — to make the transition from breast milk or formula to solid foods.

Does your baby seem interested in what you're eating? Does your baby open his or her mouth if you offer a spoon? It might be time to introduce solid foods. But don't retire those bottles or nursing pillows just yet. Make the transition to solid foods gradually.

Is your baby ready for solid foods?
Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods.

Most babies are ready to begin eating solid foods as a complement to breast-feeding or formula-feeding between ages 4 months and 6 months. Look for these cues:
* Can your baby hold his or her head in a steady, upright position?
* Can your baby sit with support?
* Is your baby interested in what you're eating?

If you answer no to any of these questions, you may want to postpone solids for a while.

What to serve when
Continue feeding your baby breast milk or formula as usual. When your baby's doctor or dietitian says it's OK to begin supplementing your baby's liquid diet:
Start with baby cereal. Mix 1 teaspoon (5 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 teaspoons (20 to 25 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals.

Some babies eat cereal with gusto right from the start. Others are less enthusiastic. Be patient. If your baby isn't interested, wait a week or two and try again.

• Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait one week between each new food. If your baby has a reaction to a particular food — such as diarrhea, rash or vomiting — you'll know the culprit.
• Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals.

To help prevent food allergies, parents were once encouraged to avoid feeding young children eggs, fish and peanut butter. Today, however, researchers say there's no convincing evidence that avoiding these foods during early childhood will help prevent food allergies. Still, it's a good idea to check with your baby's doctor or dietitian if any close relatives have a food allergy. And remember that peanut butter poses a choking hazard for babies.

What about juice?
You can offer mild, 100 percent fruit juices when your baby is 9 months old. Juice isn't a necessary part of a baby's diet, however, and it's not as valuable as the original fruit itself. If you offer juice to your baby, limit it to about 4 ounces (118 milliliters) a day, and serve it in a cup. Too much juice may contribute to weight problems and diarrhea, as well as thwart your baby's appetite for more nutritious solid foods. Sipping juice throughout the day or while falling asleep may lead to tooth decay.

Know what's off-limits
Don't offer cow's milk, citrus or honey before age 1. Cow's milk doesn't meet an infant's nutritional needs. Cow's milk isn't a good source of iron and, for infants, cow's milk can lead to iron deficiency anemia. Citrus can cause a painful diaper rash, and honey may contain spores that can cause a serious illness known as botulism.

Don't offer your baby foods that pose a choking hazard, including:
* Small, slippery foods, such as whole grapes, hot dogs and hard candy
* Dry foods that are hard to chew, such as popcorn, raw carrots and nuts
* Sticky or tough foods, such as peanut butter and large pieces of meat
* Foods that may clump together, such as raisins

For babies younger than age 4 months, also avoid home-prepared spinach, beets, turnips and collard greens, which may contain high levels of potentially harmful compounds from soil (nitrates).

Make meals manageable
When your baby begins eating solid food, mealtime is sure to become an adventure. Here's help making it more enjoyable — for both you and your baby.

• Stay seated. At first, you may feed your baby in an infant seat or propped on your lap. As soon as your baby can sit easily without support, use a highchair with a broad, stable base. Buckle the safety straps, and keep other children from climbing or hanging on to the highchair.
• Encourage exploration. Your baby is likely to play with his or her food between bites. Although it's messy, hands-on fun helps fuel your baby's development. Place a dropcloth on the floor so you won't worry about falling food.
• Introduce utensils. Offer your baby a spoon to hold while you feed him or her with another spoon. As your baby's dexterity improves, encourage your baby to dip the spoon in food and bring it to his or her mouth.
• Offer a cup. Feeding your baby breast milk or formula from a cup at mealtime can help pave the way for weaning from a bottle. By age 9 months, your baby may be able to drink from a cup on his or her own.
• Dish individual servings. Your baby may eat just a few teaspoons of food at a time. If you feed your baby directly from a jar or container, bacteria and saliva from the spoon can quickly spoil any leftovers. Instead, place small amounts of food in a separate dish. The same goes for finger foods. If your baby finishes the first serving, offer another.
• Avoid power struggles. If your baby turns away from a certain food, don't push. Simply try again another time. And again. And again, if necessary! Repeated exposure can help ensure variety in your baby's diet.
• Know when to call it quits. When your baby has had enough to eat, he or she may turn away from the spoon, lean backward, or refuse to open his or her mouth. Don't force extra bites. As long as your baby's growth is on target, you can be confident that he or she is getting enough to eat.

Enjoy your baby's sloppy tray, gooey hands and sticky face. You're building the foundation for a lifetime of healthy eating.

Breast-feeding vs. formula: What's right for your baby?

You know the benefits of breast-feeding. Still, a decision to use infant formula — alone or in combination with breast-feeding — shouldn't lead to guilt. Here's insight from a Mayo Clinic specialist.

The benefits of breast-feeding are well established. Breast milk contains the right balance of nutrients for your baby, and the antibodies in breast milk boost your baby's immune system. But if breast-feeding isn't possible, the decision to use formula shouldn't lead to guilt, says Jay Hoecker, M.D., a pediatrician at Mayo Clinic, Rochester, Minn.

Here, Dr. Hoecker answers important questions about breast-feeding and infant formula.
How long are mothers encouraged to breast-feed?

Breast-feeding until age 1 is ideal. Remember, breast milk contains the right balance of nutrients for your baby. Breast-feeding also boosts your baby's immune system. And age 1 isn't necessarily a cutoff date. Breast-feeding after age 1 continues to support your baby's growth and development.

Is any additional nutrition necessary?
Breast milk contains the right balance of nutrients for your baby. However, if you're exclusively or partially feeding your infant breast milk, talk with your doctor about vitamin D supplements for your baby. Breast milk may not provide enough vitamin D, which is essential to help your baby absorb calcium and phosphorus — necessary for strong bones. Too little vitamin D may cause rickets, a softening and weakening of bones.

What factors promote successful breast-feeding?
Taking good care of yourself can go a long way toward promoting successful breast-feeding. Eat healthy foods, drink plenty of fluids and rest as much as possible. To boost your confidence, learn as much as you can about breast-feeding. Keep the environment calm and relaxed. Look to your partner and other loved ones for support. If things aren't going well, ask for help. Friends who've successfully breast-fed may be a good source of information. Lactation consultants are available at many hospitals and clinics. Your baby's doctor can help, too.

Is it risky not to breast-feed?
Breast milk is the best food for babies. If breast-feeding isn't possible, the benefits of breast milk are lost. Still, risk is a relative term. Although breast-feeding is ideal, proper nourishment is absolutely necessary. If breast-feeding isn't working for you despite your best attempts to succeed, your baby may not receive adequate hydration or nutrition. In this case, your baby's doctor may suggest supplementing with formula. The risk of poor nutrition or dehydration outweighs all other considerations.

Does infant formula pose any risks to a baby?
Commercial infant formulas don't contain the immunity-boosting elements of breast milk. But when prepared as directed with clean water, infant formula supports healthy babies who have typical dietary needs.

Can mothers combine breast-feeding and formula-feeding?
Some mothers successfully combine breast-feeding and formula-feeding. If exclusive breast-feeding isn't possible or practical for you, remember that babies need consistency. Determine the right compromise between breast-feeding and formula-feeding and follow a consistent schedule.

How should mothers who choose not to breast-feed handle feelings of guilt or inadequacy?
Guilt is rarely a productive emotion. Instead, focus on your baby. Nurture your baby, and make sure he or she is well nourished. Share your feelings with your doctor, your baby's doctor or others in your support circle. Remember, parenting is an adventure that requires choices and compromises. What counts is doing the best you can as you face this new challenge.

Infant formula: Which formula is right for your baby?

Sometimes exclusive breast-feeding isn't possible. Here's what you need to know about choosing infant formula.

Infant formula can be a practical and safe alternative to breast milk. Breast milk is the best source of infant nutrition. However, providing breast milk for the entire first year of life may not be feasible for all mothers. Infant formulas offer another option.

Following are answers to common questions about infant formulas.
What are the main types of infant formula?

Commercial infant formulas are regulated by the Food and Drug Administration (FDA). Three major types are available:

• Cow's milk formulas. Most infant formula is made with cow's milk that has been altered to resemble breast milk. This gives the formula the right balance of nutrients — and makes the formula easier to digest. Most babies do well on cow's milk formula. But some babies, such as those allergic to the proteins in cow's milk, need other types of infant formula.
• Soy-based formulas. Soy-based infant formulas may be an option for babies who are intolerant or allergic to cow's milk formula or to lactose, a sugar naturally found in cow's milk. Soy-based formulas can also be useful if you want to exclude animal proteins from your child's diet. However, babies who are allergic to cow's milk may also be allergic to soy milk.
• Protein hydrolysate formulas. These are meant for babies who have a family history of milk or soy allergies. Protein hydrolysate formulas are easier to digest and less likely to cause allergic reactions than are other types of formula. They are also called hypoallergenic formulas.

In addition, specialized formulas are available for premature infants and babies who have specific medical conditions.

Why use formula instead of regular animal or plant milk?
Commercial infant formulas provide all the nutrients that most infants need. Milk from animal or plant sources doesn't contain these nutrients in a healthy balance for your baby. For example, infants who drink such milk are at risk of iron deficiency.
What infant formula preparations are available?

Infant formulas come in three forms. The best choice depends on your budget and desire for convenience:

• Powdered formula is the least expensive. Each scoop of powdered formula must be mixed with water.
• Concentrated liquid formula also must be mixed with water.
• Ready-to-use formula does not need to be mixed with water. It's the most convenient type of infant formula. Ready-to-use formulas are also the most expensive — especially when packaged in disposable bottles.

What's the difference between generic and brand-name infant formulas?
All infant formulas sold in the United States must meet the same nutrient standards set by the FDA. Although manufacturers may vary in their formula recipes, the FDA requires that all formulas contain the same nutrient density.
Should infant formula be iron fortified?

Yes. Your baby needs iron to grow and develop — especially during the first year of life. If you're not breast-feeding, using iron-fortified formula is the easiest way to provide this essential nutrient.

Should you buy enhanced infant formulas?
Some infant formulas are enhanced with docosahexaenoic acid (DHA) and arachidonic acid (ARA). These are omega-3 fatty acids found in breast milk and certain foods, such as fish and eggs.

Some studies suggest that adding DHA and ARA directly to infant formula can help infant eyesight and brain development. Other research has shown no benefit. Ask your child's doctor for guidance.

Manufacturers of infant formulas have added pre- and probiotics — to promote the presence of healthy bacteria in the intestines — to their formulas in an effort to mimic the immune benefits that breast milk provides. Some studies are encouraging but long-term benefits of these are unknown.

How important is the expiration date on an infant formula?
If the expiration date has passed, you can't be sure of the formula's quality. Don't buy outdated formula. While checking the expiration date, also inspect the condition of the formula can. Don't buy cans with bulges, dents, leaks or rust spots. Formula in a damaged container may be unsafe.

How long should you use infant formulas?
You can generally use infant formula until a child's first birthday, but talk to your child's doctor for more specific guidance.

After you stop using infant formula, don't give your child reduced-fat or skim milk. While eating a balanced diet, these do not have enough calories or fat for a growing child.

Feeding your newborn: What you need to know

A newborn's feeding schedule can be unpredictable. Here's what, when and how to feed your baby.

Whether you're a new parent or an experienced one, you may have questions about feeding your quickly changing and growing newborn. Here's what you need to know.

Stick with breast milk or formula
In most cases, breast milk is the ideal food for babies. Breast-feeding provides physical and emotional benefits for both mothers and newborns, and most experts recommend exclusive breast-feeding for at least the first six months of life.Whether you feed your newborn breast milk or formula, avoid giving water, juice or other fluids. Introducing these liquids too soon can cause diarrhea.

Other key points to keep in mind:

• Feed your baby on demand. Most newborns breast-feed eight to 12 times a day — about every two to three hours. Within two to three months, your baby may be satisfied with six to eight feedings a day. Eventually your baby will fall into a fairly predictable feeding schedule, taking in more milk in less time at each feeding. If you feed your baby formula, you'll need to feed a little less often because formula digests more slowly than breast milk does.
• Discuss vitamin D. If you're exclusively or partially feeding your infant breast milk, talk with your doctor about vitamin D supplements for your baby. Breast milk may not provide enough vitamin D, which is essential to help your baby absorb calcium and phosphorus — necessary for strong bones. Too little vitamin D may cause rickets, a softening and weakening of bones.
• Follow your baby's feeding cues. Look for early signs of hunger, such as stirring and stretching, sucking motions and lip movements. Fussing and crying are later cues. The sooner you begin each feeding, the less likely you'll need to soothe a frantic baby. Of course, not every cry means hunger. Sometimes your baby may simply need a clean diaper, a change of scenery or some cuddle time.
• Know when your baby is full. When babies stop sucking, close their mouths or turn away from the nipple, they may be full — or simply taking a break. Try burping your baby or waiting a minute before offering your breast or the bottle again. If your baby is ready to end the feeding, he or she will resist more vigorously. In general, breast feedings should last at least 10 minutes — and usually no more than 20 minutes — per breast.
• Expect variations in your baby's eating patterns. Your baby won't necessarily eat the same amount every day. During growth spurts — often at 10 to 14 days after birth, as well as at three weeks, six weeks, three months and six months — your baby may take more at each feeding or want to feed more often. After a few days, the pattern should become more predictable. When your baby begins to drop middle-of-the-night feedings, he or she may want a morning "catch-up" feeding.
• Trust your instincts — and your baby's. Parents often worry that their newborn isn't eating enough. But babies usually know just how much they need. Don't focus on how much, how often and how regularly your baby eats. Instead, look for contentment between feedings, alertness, good skin tone and steady weight gain — about 4 to 7 ounces a week for the first month.
• Know the signs of underfeeding. If your newborn isn't gaining weight, wets fewer than six to eight diapers a day or doesn't have regular bowel movements, seems sleepy all the time, and shows little interest in feeding, he or she may not be getting enough to eat. If you notice any of these signs or have concerns, call your baby's doctor.
• Get regular well-baby checkups. Your baby's doctor will likely want to weigh your newborn and discuss feeding 48 to 72 hours after you and your baby leave the hospital. Be sure to keep this and other follow-up appointments so that you and your doctor can track your baby's progress.
• Consider each feeding a time to bond with your baby. For babies, feeding is as much a social activity as a nutritional one. Your baby's growth and development are based, in part, on the powerful bond that forms during feedings. Hold your baby close during each feeding. Look him or her in the eye. Speak with a gentle voice. If you're using a bottle, resist the temptation to prop it in your baby's mouth while you do other things. This could lead to choking or tooth decay — and a missed opportunity to build your baby's sense of security, trust and comfort.

Infant development: What happens from birth to 3 months?

Babies change dramatically in the first few months. Consider major infant development milestones in the first three months — and what to do when something's not right.

A lot happens during your baby's first three months. Most babies reach certain milestones at similar ages, but infant development isn't an exact science. Expect your baby to grow and develop at his or her own unique pace. As you get to know your baby, consider these general infant development milestones.

What to expect
At first, caring for your baby may feel like an endless cycle of feeding, diapering and soothing. But soon, signs of your baby's growth and development will emerge.

• Motor skills. Your newborn's head will be wobbly at first. But within the first few months, most babies can face straight ahead while lying on their backs and lift their heads while lying on their tummies. Although newborns aren't likely to roll over, your baby may soon turn from side to back. Your baby's stretching and kicking is likely to get more vigorous. If you offer a toy, your baby may grasp it and hold on tight for a few moments.
• Hearing. Within a few weeks, your baby may respond to loud noises by blinking, startling, frowning or waking from light sleep. Even everyday household sounds — footsteps on the floor, water running — may elicit subtle responses, such as increased limb movement or slowed sucking rhythm. Expect your baby to respond to the sound of your voice.
• Vision. Most newborns focus best on objects about 12 inches away, or the distance to your face during a feeding. Soon your baby may begin to examine more complex designs, along with various colors, sizes and shapes. You may notice your baby studying his or her hands and feet. By age 3 months, your baby may be easily distracted by an interesting sight or sound.
• Communication. Newborns are sensitive to the way you hold, rock and feed them. By age 2 months, your baby may smile on purpose, blow bubbles and coo when you talk or gently play together. Your baby may even mimic your facial expressions. Soon your baby may reach for you when he or she needs attention, security or comfort.

Promoting your baby's development
Your relationship with your child is the foundation of his or her healthy development. Trust your ability to meet your baby's needs.

• Hold your baby. Gentle caresses and tender kisses can help your newborn feel safe, secure and loved. Hold and rock your baby. Allow him or her to study your face. Let your baby grasp your little finger and touch your face.
• Speak freely. Simple conversation lays the groundwork for language development, even before your baby can understand a word. Ask questions and respond to your baby's coos and gurgles. Describe what you see, hear and smell around the house, outdoors, and when you're out and about. Use simple words that apply to your baby's everyday life. Remember that your tone of voice communicates ideas and emotions as well.
• Change positions. Hold your baby facing outward. With close supervision, place your baby on his or her tummy to play. Hold a colorful toy or make an interesting noise to encourage your baby to pick up his or her head. Many newborns get fussy or frustrated on their tummies, so keep these sessions brief at first — just a few minutes at a time. If drowsiness sets in, place your baby on his or her back to sleep.
• Respond quickly to tears. In any given day, the average newborn cries for more than two hours. Whether your baby needs a diaper change, feeding session or simply warm contact, respond quickly. Your attention will help build a strong bond with your baby — and the confidence he or she will need to settle down without your help one day.

When something's not right
Your baby may reach some developmental milestones ahead of schedule and lag behind a bit on others. This is perfectly normal. There's typically no cause for concern. It's a good idea to be aware of the warning signs, however.

Consult your baby's doctor if you're concerned about your baby's development or you notice any red flags by age 3 months:
* No improvement in head control
* No attempts to lift the head when lying facedown
* Extreme floppiness
* Lack of response to sounds or visual cues, such as loud noises or bright lights
* Inability to focus on a caregiver's eyes
* Poor weight gain

Remember that every baby is unique — but your instincts are important, too. The earlier a problem is detected, the earlier it can be treated.