First Four Months

Every time a Baby is born.... a Mother is born.

Oh! The joys of motherhood.
The immense pleasure on your glowing face as you tenderly croon your little one to sleep will make you realize that the gift of motherhood is the most fulfilling of all.

A baby becomes an inseparable part of the mother and the entire family by being the harbinger of cheer, happiness and celebrations. As soon as your baby opens her eyes to the outside world, you become the center of her existence and this tiny precious life becomes totally dependent on you for security, safety and sustenance. You will be amazed at how she trustingly curls her fingers around yours; cherubically innocent in her sleep.

The stage from birth till your little one is one year is called INFANCY. These vital first weeks can be nerve racking even if you are totally prepared. Here are some reassuring guidelines to help you sail through these busy months which will be full of mixed emotions of joy, love, insecurity, triumph, anxiety and a whole new world of new experiences.

The birth of your baby will transport you into a new phase of life - one that is both challenging and rewarding. Take one day at a time and give yourself the opportunity to develop as a parent and to experience the joys of parenting.

Have faith in yourself and the special bond that you share with your baby. In times of real doubt, take advice from your pediatrician just as I have and follow the God given "Mother's Instinct".

When your baby arrives in this world, she will do so with gusto, crying loudly for you and instinctively clamouring for your milk. Nature waves her magic wand and most mothers start producing breast milk immediately after they deliver. However, for some mothers, this process may take a day or two as your body adapts to hormonal changes. This is quite natural and nothing to worry about. Breast feeding brings its own rewards, and like so many aspects of parenthood, it's an art that needs to be learned. To some, it comes easily while others may need more patience.

It's the comfort of being held by you during feeding that strengthens the deep intangible emotional bond between you and your baby. As you cradle your little one closely, this is the closest she can be to the fetal position she's been accustomed to in your womb before birth and so this position provides maximum security for your little one.

Once you start breast feeding (lactating) for the first day or two, a yellowish translucent fluid called colostrum, is secreted in place of breast milk, that is quite distinct from the breast milk. This fluid is rich in antibodies that build and strengthen your baby's immune system.
Colostrum is rich in proteins that are vital for your baby's growth and are satiating, thus ensuring that your baby sleeps soundly for longer hours during the first few days. This is nature's way of letting you to recover from labour.
Within the next three or four days, this yellowish liquid transforms into mature milk which will provide complete nourishment to your baby in the months to come. It is divided into two components - fore milk and hind milk, both of which have specific purposes to serve.

Fore milk, as the name suggests, is secreted at the beginning of the feed and the hind milk towards the end. Fore milk is thinner, rich in protein, lactose, vitamins, minerals, water and low in fats. Fore milk is extremely important as it provides all the above nutrients that are vital for babies, at the same time quenching their thirst. Hence, there will be no need to feed any other liquid to the little one for the first four months.

Hind milk is thicker, more opaque and abounds in fats and will satiate baby's hunger. Hence, mother's milk is a complete meal in itself and takes care of baby's nourishment. It is important that you allow baby to continue sucking from one breast until she gets to the hind milk and leaves the breast at her own will.

Baby's feed time can be one of the most enjoyable aspects of early parenthood. It is a special time together, inspiring warmth and security, and builds an enduring bond between you and your bundle of joy. In a busy household, it provides you an occasion to relax and also revel in your tiny creation.
For the initial four months, mother's milk serves as the natural self-contained complete food for babies.

Here let me share with you a few wonders of breast milk, which make it a complete food for your baby.

	Breast milk is the purest form of milk provided by Mother Nature. Providence has provided this source of completely natural nourishment keeping it at the right temperature for your baby to drink. As breast milk does not demand any pre-preparations in terms of heating and cleaning, the chances of contamination of milk decrease. The chances of overfeeding are also less as your baby will not take more than it needs.
	Breast milk is easily available for your baby at any time and any place. It is ready to drink and thus the chances of preparing incorrect formula are less.
	It is rich in antibodies, which increase the immunity in babies, protecting them from cold, cough, influenza etc.
	Breast milk contains a protein called lactalbumin, and an enzyme called amylase, that aids in digestion and converts the milk into a soft curd that is easily digested by newborns.
	A breast fed baby will also have a reduced likelihood of allergic reactions, as the proteins present in the breast milk are less likely to cause allergies.
	Lactose is a form of sugar present in breast milk which facilitates the absorption of vital nutrients like calcium and magnesium.
	A part from this, the action of sucking milk from the breast promotes the development of jaw and facial muscles of your baby.
	It has universally been accepted that breast milk is the complete and only complete source of nourishment appropriate for your baby till the age of 4 months. All the nutrients required by your little one are present in the right quantities. When and how much to Feed your Baby? Once your baby has breathed the outside air, its most instinctive and natural action will be to nuzzle your breast and to suck at it. Mother Nature has granted mankind absolutely hygienic nourishment for infants. However, you may be left wondering as to when and how much to feed your little one You can feed your baby whenever she cries, irrespective of the time of the day. This natural feeding method is known as demand feeding. Initially, your baby may not feed at regular intervals. Please don't panic, as this is quite natural. The important thing is that the baby be allowed to suck at the breast without restriction; she should be able to feed whenever she wants and for as long as she wants. In the beginning, the interval between two feeds can be approximately 2 ½ to 3 hours as she can consume only small portions. By the end of the second month, the feeding patterns established in the early days can change suddenly and inexplicably. As the days pass, your little one will begin to establish her own routine and will become 'self-scheduling'. She will soon create her own pattern of feeding. As her appetite increases, the feeds will get longer and gradually the gap between feeds will also increase. Try not to fix any rigid timing or follow a regimental, artificially systematized timing to feed your baby as there is no place for clock watching here. It is important to feed your baby from both the breasts. Your baby, if left to her own resources, will never want to leave the security of your arms and will enjoy being stuck to your bosom indefinitely. Most pediatrician recommend that once your baby has adjusted to breast feeding, she should be fed for 20 minutes at each breast, as this will also be more comfortable for you. If you are constantly feeding from one breast, the other one will remain heavy. Burp your 'precious', once half way through the feed and then again after the feed is over. This helps release any wind that has been swallowed by baby during feeding or crying. However, if your baby falls asleep while feeding, do not disturb her slumber. Put her on her side and not on her stomach or back and gently pat her back to allow the wind to escape. Some milk may also run out of your baby's mouth with this burp. This is normal and there is no need to worry about it, unless the baby looks uncomfortable. Wipe it off with a clean napkin and continue feeding, if you are half way through the feed. Sometimes babies burp on its own during the feed and this is also a sign that baby has had her fill. It is not necessary to burp the baby again, in such a situation. Alternatives to Breast Feeding Sometimes large amounts of milk is produced two or three days after delivery but it may also take a while for your baby to get used to sucking and her efforts may cause sore nipples, preventing you from nursing. You may also be recovering from surgery and not in a position to breast feed immediately. At such times, you can still feed the baby your own milk by expressing breast milk and refrigerating it till it is required. Breast milk can be safely stored for 4 to 6 hours at room temperature and 24 hours, if refrigerated. It is imperative to pay meticulous attention to hygiene. Always remember to warm the milk in a sterilized container, before feeding your baby. If you do find it difficult to breast feed your little one initially, try and be patient and do not give up easily. The way to make breast feeding a success is to continue to breast feed, as the production of milk in the breasts is dependent upon the amount the baby feeds. In case you do need to start substitutes like top milk (milk of cow or buffalo) or powdered milk, consult your pediatrician as he will know what's best for your baby. These substitutes will also satisfy your baby's nutrient requirements just as breast milk. Pediatrician recommend breast milk as their first choice because it contains valuable antibodies that strengthen baby's delicate immune system. Cow's milk is the ideal substitute as its nutritional quality is very close to that of mother's milk. However, research shows that the protein content of cow's milk is triple the amount in breast milk and such high proteins are not required for your baby at this stage. So if you choose cow's milk, then it is important to dilute three parts of this milk with one part of sterilised water. Buffalo's milk, on the other hand, has a higher fat content and may be difficult for your little one to digest in the early months. Powdered milk formulas should be given second priority, as the chances of over and under dilution are higher as compared to cow or buffalo's milk. If you choose to start on formula milk, follow the instructions given on the package accurately. If you feel the need to make any changes in the dilution instructions, do so only after consulting your pediatrician. Remember to sterilise all the containers that will be used to prepare formula and to feed your baby. Also ensure that sterilised water is used to dilute formula milk. While preparing a feed for your baby, one objective needs to be top most on mind - to provide a safe, easily digestible, hygienic and nutritious meal for this precious life. Whether you choose cow's milk or buffalo's milk, boiling the milk prior to feeding is essential and will ensure safe and micro-organism free milk for your baby. If the milk is refrigerated, you will need to warm it to room temperature. It is always safe to check the temperature of the milk by pouring a few drops of milk on your wrist or the back of your palm to ensure that it is tepid. Also, check for the quality of milk by tasting it. If it tastes sour, discard it immediately as it may be harmful for your little one. Do not be anxious or feel guilty if, for some reason, you cannot breast feed your baby, as this may only be a temporary phase. Above all, its important to remember that your baby's future is shaped more by good parenting and less by the kind of milk you choose. Lactose Intolerance Biologically speaking, it is most natural for a baby to be fed on mother's milk or a similar substitute. However, some mums may spend agonizing moments wondering why their little one vomits or has loose motions after she has had milk, when the baby next door happily gurgles down milk. Lactose is a form of sugar present in milk, which is broken down into simple sugars with the help of an enzyme called lactase that is produced by our bodies when we consume milk. Some babies may produce lactase in insufficient quantities and therefore are unable to digest milk. This is commonly known as lactose intolerance. A deficiency of this enzyme may cause an inability to digest milk, due to which some infants may develop colic, get diarrhea or even start vomiting on consuming milk. Some babies may be able to digest dairy products like curds and paneer only to a certain extent when they are older. Others may tolerate milk when mixed with other foods. However, this could be a temporary phase as the body produces lactase only as and when it is required i.e. when one consumes milk. If the baby is not able to digest milk at all, then you need to consult a pediatrician who is the best guardian of your baby's health. He will keep in mind your baby's special needs and will recommend other substitutes like soya milk or groundnut milk which has a different type of sugar and are easier to digest. Mother's Diet During Lactation A newborn baby radiates irresistible appeal and can transform even the most sophisticated parents into doting protectors. You will obviously always be anxious and careful about your li'l one's health. This protective instinct will urge you to pay great attention to your own diet, especially while you are breast feeding. Your baby depends totally on you for its sustenance, especially during the first 4 months after birth. Your breast milk is dependent upon the quality of food and quantity of fluids you consume. This, in turn, will directly affect your baby's nourishment and well being. Hence, you need to follow a sensible diet, one that includes vital food elements and keeps you both healthy and well. Most mothers continue to breast feed for about a year, slowly letting the little one get accustomed to top milk and other foods during the weaning process. Pediatrician recommend breast feeding babies for a year, out of which the first four months, the baby should be exclusively breast fed. If you decide to follow the same pattern, you will need to consume at least 2400 to 2700 kcal every day during first 6 months of lactation. At this time, the energy requirements of your body are higher as you will be exclusively breast feeding your baby. However, in the latter 6 months, when you start weaning by introducing variety in your baby's diet, you will breast feed less frequently and so yourenergy requirement will decrease to 2250 to 2550 kcal every day.  Lactation draws onto your energy resources and burns 3500 kcal per day. You do realize that you will actually be burning more calories than you are consuming. Are you quizzical about the source of these extra calories? Hidden here is another miracle of nature. This will be the time to use maternal stores that you have accumulated during your pregnancy. Mother Nature will go about "Her work", helping you to shed those extra kilos you will have gained during pregnancy. This is the time for getting back into shape naturally, provided you eat wisely. One point I would like to explain here, is the relation between calories (cal) and kilocalories (kcal). They represent the same values and are referred to by two different names i.e. calories and kilocalories. Supplement your diet with plenty of wholesome foods such as: Cereals such as wheat, rice, bajra etc. Dals and pulses such as moong dal, rajma, soyabean etc. Dairy products like milk, pasteurized cheese, paneer, curds, etc. Fruits, vegetables and their juices. While you are lactating, you will need to consume more protein too. The requirement is approximately 70 to 75 gm per day during the first 6 months of lactation. As you supplement breast milk with weaning foods, your protein requirement should decrease a little by 5 to 7 gm i.e. to about 63 to 70 gm per day. Make the following protein rich foods a part of your diet Dals such as moong dal, toovar dal, masoor dal etc. Pulses like rajma, chawli, chana etc. Dairy products like milk, pasteurized cheese, paneer, curds, etc. Nuts and oilseeds (almonds, cashewnuts, til, groundnuts etc.) In particular soyabeans are considered to be an excellent source of vegetarian protein. Vitamin C is one of the most important nutrients, keeping colds and coughs at bay by strengthening immunities of both mummies and babies. So your need for vitamin C doubles during lactation to about 80 mg per day. Good sources of vitamin C are Citrus fruits like orange, guava, lemon, sweet lime etc. Vegetables such as capsicum and cabbage. Amla Amla is a gold-mine of vitamin C, one small amla per day fulfils your daily requirements for this nutrient. Vitamin C is highly unstable and is lost during cooking except in the case of amla which retains most of its potential even after being cooked. Calcium is one of the most vital minerals essential for the development of your baby's bones and teeth (1000 mg per day). Breast milk is a good source of calcium. A word of caution here; the calcium levels in breast milk are not affected even if your diet lacks in calcium rich foods but in such a situation breast milk unfortunately, derives its calcium from your bones, making them weak. This may lead to deficiencies later on in life and can cause osteoporosis. So, you must have plenty of calcium rich foods like dairy products, ragi and green leafy vegetables. Make the following foods an essential part of your diet Dairy products like milk, pasteurized cheese, paneer, curds, etc. Dark green leafy vegetables such as spinach, fenugreek etc. Soyabean and its products such as tofu, soya nuggets etc. Til and ragi Iron is an essential component of hemoglobin that supplies oxygen to each cell of our body. Although your baby has adequate stores of iron that lasts till 4 months of age and breast milk is a poor source of iron, you require iron (30 mg per day) to maintain yourself in a good health. To make up for your iron requirements consume Dark green leafy vegetables such as spinach, cow pea leaves, fenugreek etc. Nuts such as almonds, cashewnuts etc. and oilseeds such as til and garden cress seeds Dried fruits like raisins, dates etc. Whole grain cereals and pulses such as bajra, cow pea, dry peas etc. Jaggery Folic acid plays a major role in multiplication and formation of new cells in our body. To prevent the folic acid anaemia, you need to consume 150 mcg of folic acid per day. Increase your folic acid levels by enjoying Vegetables such as cluster beans, soyabean, spinach, peas, broccoli, beetroot, ladies finger, potato etc. Cereals like bajra, wheat etc. Nuts like almonds, cashewnuts, walnuts etc. and oilseeds such as til. Vitamin B12 (1.5 mcg per day) is essential for proper functioning of all cells of your as well as your baby's body. In comparison to non-vegetarian foods, vegetarian diets are deficient in Vitamin B12. But don't let that hamper your spirits as soya and it's products such as soya milk, soya nuggets etc. in particular provide an appreciable amount of this vitamin. Vitamin D is also an important nutrient which aids the absorption of calcium. It is synthesized in our body in the presence of sunlight. Hence, there is no dietary recommendation for this nutrient. In addition to the above nutrients, you must also include foods like almonds, fenugreek (methi), garlic, milk, and garden cress (subza) seeds etc. to stimulate the production of breast milk. These foods are called galactogouges. A liberal intake of fluids is equally important as the production of breast milk is also dependent on the amount of fluid you consume daily. Have at least 4 litres (or more but not less) of fluid daily during lactation along with plenty of juices, soups, dals, buttermilk etc. This will help to enhance milk production and also maintain the fluid balance in your body.    Recommended Dietary Allowance Along with your recommended dietary allowance (RDA), Indian Council of Medical Research (ICMR) has also suggested a recommended Dietary allowance, as shown in Table 1, to meet the nutritional requirements of your little one in the first three years. Table 1: Recommended Dietary Allowance for Infants and Toddlers as suggested by ICMR Nutrients 0 to 6 months 6 to 12 months 1 to 3  years Energy 108 kcal/kg 98 kcal/kg 1240 kcal Protein 2.05 gm/kg 1.65 gm/kg 22 gm Fat - * -* 25 gm/day Calcium 500 mg 500 mg 400 mg Iron 1 mg/kg * * 1 mg/kg 12 mg Vitamin A - Retinol  - Beta Carotene 350 mcg 1200 mcg 350 mcg 1200 mcg 400 mcg 1600 mcg Vitamin C (Ascorbic acid) 25 mg 25 mg 40 mg Vitamin D 200 to 400 IU 200 to 400 IU 200 IU Vitamin B1 (Thiamin) 55 mcg/kg 50 mcg/kg 0.6 mg Vitamin B2 (Riboflavin) 65 mcg/kg 60 mcg/kg 0.7 mg Vitamin B3 (Niacin) 710 mcg/kg 650 mcg/kg 8.0 mg Vitamin B6 (Pyridoxine) 0.1 mg 0.4 mg 0.9 mg Vitamin B12 (Cyanocobalamin) 0.2 mcg 0.2 mcg 0.2 to 1.0 mcg Folic Acid 25 mcg 25 mcg 30 mcg Vitamin E 5 IU 5 IU *** * Although ICMR has not made any specific recommendations for the consumption of fats for babies, it is essential in moderation for the healthy growth and development of your baby. ** Breast milk is a poor source of iron. However babies are born with adequate iron stores which suffice their daily requirement for the first 4 months. Therefore the requirement for this nutrient begins only after the age of 4 months. *** After the age of 1 year there is no specific recommendation for vitamin E as most of the foods we consume like cereals, pulses, fruits and vegetables contain plenty of vitamin E.