What to Expect the First Year (62 page)

Convinced you're ready to make the switch from breast to bottle now? First—if you haven't already—you'll need to make sure your little one is acclimated to her new source of nourishment: the bottle. It's probably best to fill the bottles with formula at this point, so your milk supply will begin to taper off. Be persistent when offering the bottle, but don't push it. Try giving the bottle before the breast at each feed—and if your baby rejects the bottle the first time, try again at the next feeding. (
Click here
for more tips on introducing the bottle, especially if you're having trouble selling the store-bought nipple.)

Keep trying until she takes at least an ounce or two from the bottle. Once she does, substitute a meal of formula for a nursing at a midday feeding. A few days later, replace another daytime breastfeeding with formula, increasing the number of total ounces. Making the switch gradually, one feeding at a time, will give your breasts a chance to adjust with a minimum of really uncomfortable engorgement. Eliminating the early morning and late evening feeds last may make sense, since that will give you the option of hanging on to them for as long
as you'd like, even once you've started back to work—assuming your milk supply holds out, and your baby's still interested. Those are, after all, typically the most emotionally gratifying feeds of the day.

“I was happy with my decision to skip bottles with my baby … until I realized it's almost impossible to have a night out without him. And now he won't take a bottle, even of pumped milk.”

Breastfeeding is hands down the easiest way to feed your baby—that is, if you're with him. Step out for the night, and the logistics get a little complicated. After all, it's hard to do dinner and a movie when baby's got to eat, too—and your date's scheduled to last longer than the window between two feeds.

You can always try, try, and try again with the bottle (keeping in mind that he may be more likely to accept a mama substitute when mama's not around). If you still don't succeed, opt for a movie or dinner—or order up dinner and Netflix at home instead for now.

Once baby starts going for longer stretches at night between feeds and starts filling his tummy with solids and drinks from a cup, too (usually around month 6), getting a night out will no longer be an impossible dream—assuming you can secure a sitter. In the meantime, if you have a special event you'd like to attend that will keep you from home for more than a few hours, try these tips:

• Take baby and sitter along, if there's an appropriate place for them to hang out while they're waiting. That way baby can nap in a stroller while you enjoy the event, slipping out to nurse as needed.

• If the event is out of town, consider taking the family along. Either bring your own sitter or hire one where you will be staying. If the place where you're staying is near enough to the event, you can pop in at feeding time.

• Adjust baby's bedtime, if possible. If your baby doesn't usually go to bed until after 9, and you need to leave at 7, try to get him to cut down on his afternoon nap and put him to bed a couple of hours early. Be sure to give him a full nursing before you leave, and plan on feeding him again when you return home, if necessary.

• Leave a bottle of expressed milk and hope for the best. If your baby wakes up and is really hungry, he may take the bottle. If he doesn't take it, well, that's what you pay a good sitter the big bucks for—just make sure you prepare her for the possibility of a fussy baby, and be ready to feed as soon as you get home. Keep your cell phone handy, and be prepared to cut dinner off at the entrée and run home to feed baby.

“I'm concerned that my baby may be constipated. She's exclusively breastfed and has always had six or eight bowel movements a day—but lately she's been having just one, and sometimes she even misses a day.”

Don't be concerned … be grateful. This slow-down in production isn't only normal, but it will send you to the changing table less often. Definitely a change for the better.

Many breastfed babies start having fewer bowel movements somewhere between 1 and 3 months of age. Some will even go several days between movements. That's because as babies get bigger, their bowels get bigger and longer, too, allowing waste to hang out longer before exiting. What's more, fluid is better able to be absorbed, resulting in fewer, larger poops. Other babies will continue their prolific poop production as long as they are nursing, and that's normal, too. What's regular … is what's regular for her.

Constipation is rarely a problem for breastfed babies—and what's more, infrequency isn't a sign of it. Hard, difficult-to-pass stools are (
click here
).

“I change my baby's diaper frequently, but she still gets diaper rash—and I have trouble getting rid of it.”

Diaper rash is typically triggered by a combination of moisture (too much), air (too little), friction (rubbing against those soft folds of skin), and irritants (think everything from urine and stool to the ingredients in disposable diapers, wipes, bath products, and laundry detergents). And since that pretty much sums up what your baby's bottom is exposed to most of the day and night, it's no wonder she (like a third of her comrades-in-diapers) isn't sitting on a pretty bottom. You can expect diaper rash to remain a potential problem as long as your little one is in diapers, but don't be surprised if things get worse before they get better. Often, when a more varied diet is introduced, what comes out the other end is even more irritating to baby's tender skin, leading to redness and rash. Exacerbating the rash is aggressive and frequent cleansing of that often dirty diaper area. You may also notice the rash is worse where urine concentrates in the diaper, toward the bottom with girls and the front with boys.

There are many different types of diaper rash, from the more common chafing dermatitis (redness in areas of high friction) to candidal dermatitis (bright red rash in the crease between the abdomen and the thighs), seborrheic dermatitis (a deep red rash with yellow scales) to impetigo (large blisters or crusts that weep, then ooze yellowish fluid before crusting over) and intertrigo (a red area of skin that might ooze white to yellowish gunk).

The best cure for your sweet pea's garden-variety diaper rash is prevention (
click here
). Too late for that? The following may help eliminate your baby's simple diaper rash, as well as help ward off recurrences:

Less moisture.
To reduce moisture on that tender skin, change your little one's diaper often—preferably (at least for now) right after she pees or poops.

More air.
After you've cleaned her up, but before you've replaced the diaper, give her bottom some bare air time (just make sure the surface you choose to let her enjoy the breeze on is covered with an absorbent pad or towels in case she springs an unexpected leak). No time for air time? Blow on her bottom or use the clean diaper to fan her bum dry. Also, try to leave a little breathing room in the diaper when it's on. You want your baby's diaper snug enough to prevent leaks but not so tight that it rubs and chafes. If she's in cloth diapers, use breathable diaper wraps.

Fewer irritants.
You can't do much about the pee and poop that rubs her bottom the wrong way (besides change her frequently), but you can avoid adding extra irritants to the mix. Make
sure all the products that touch your baby's tush are gentle and unscented (that goes for wipes, too). When baby's really rashy, try to skip the wipes and instead dab her bottom clean with warm water and cotton balls, or even a soft washcloth.

Different diapers.
If your baby has a recurrent diaper rash, consider switching to another type of diaper (from cloth to disposables or vice versa, from one type of disposable to another) or another brand of wipes to see if the change makes a difference.

Blocking tactics.
Spreading a thick, protective layer of ointment or cream (A&D, Desitin, Balmex, Boudreaux's Butt Paste, Aquaphor, or whatever your baby's doctor recommends) on baby's bottom after cleaning it at changing time will prevent urine from reaching it and irritating the rash further. Make sure, though, that before you spread the ointment or cream on baby's bottom, her skin is completely dry (trapped moisture beneath the barrier cream will only make diaper rash more likely—or make a bad diaper rash worse).

If a rash doesn't clear up or at least start improving in a day or two, or if blisters or pustules appear, check in with the doctor, who may prescribe a topical antifungal cream or ointment, a steroid cream, or, much less likely, an oral antibiotic.

“I'm concerned about a red, raw area at the tip of my baby's penis.”

Thought diaper rash only shows up on your baby's sweet bottom? Not always. That red area on your little one's penis is probably nothing more than a localized diaper rash—and it's pretty common. But just because it's common doesn't mean you should ignore it. Left untreated such a rash can occasionally cause swelling, and in rare instances, that swelling can make it difficult for a baby to pee. So do everything you can to get rid of the rash, following the tips for treating diaper rash in the previous answer. And if you're using home-laundered diapers, switch to a diaper service or disposables until the rash goes away. The rash is staying put? If two or three days of home treatment doesn't help, put in a call to the doctor.

“When my son tries to reach for something, he can only swat at it—and his movements are so random, not coordinated. Is that normal?”

Though it has come a long way from the days when you felt tiny twitches in your uterus, your baby's nervous system is still young and inexperienced, and it hasn't worked out all its kinks. When his arm whips out in the direction of a toy but doesn't land anywhere near its target, it may seem random—but it's actually a normal stage in infant motor development. Soon he'll gain more control, and the purposeful, clumsy batting will be replaced with more skilled, coordinated reaching movements. And once he gets to the stage when nothing within that cunning reach is safe again, you may look back fondly on a time when he looked but wasn't able to touch.