Feeding your baby is challengin and rewarding. Feeding provides nutrition for your baby’s physical and mental growth. It is also an opportuniaty for you to love, touch and communicte with your baby.
When your baby gains weight steadily and is content and thriving, it’s reassuring and rewarding. But if your baby has congenital heart disease, you may have to use different feeding methods. A baby born with a heart defect may not gain weight as rapidly as other infants, despite your hard work and persistence. This Web site provides information to help you cope with your baby’s feeding needs.
Your Baby’s Growth
If your baby has a congenital heart defect, it means the heart or blood vessels near the heart didn’t develop normally before birth. Often the term congenital heart disease is used to mean the same thing.
Healthy babies usually double their birth weight between four and five months of age. A baby with a congenital heart defect may grow more slowly during infancy and childhood. Growth often varies according to the type and severity of heart disease. An eight-ounce to one-pound gain in a month may be an acceptable weight gain for a baby with a heart defect. Infants and children with congestive heart failure or cyanosis (blueness) tend to gain weight slowly.
Congestive heart failure occurs when the heart muscle is doing extra work and can’t easily meet the body’s needs. It doesn’t mean that the heart “fails” to beat. Congestive heart failure is usually treated with medicines that help to strengthen the heart muscle’s pumping and get rid of excess fluid in the body. Babies with congestive heart failure may grow in height but gain weight slowly.
Some factors related to congenital heart defects that can interfere with growth include:
- rapid heart beat
- poor appetite
- greater caloric needs associated with a heart defect
- decreased food intake due to rapid breathing and fatigue
- frequent respiratory infections (bronchitis, pneumonia)
- poor absorption of nutrients from the digestive tract
- decreased oxygen in the blood (hypoxia)
A baby’s growth also may be influenced by hereditary or genetic conditions. The most common reason for poor growth is that the baby isn’t taking in enough calories or nutrients. But even if your baby seems to drink enough formula or breast milk, he or she may still gain weight very slowly.
You don’t need to try to weigh your baby often at home. Babies gain or lose weight from day to day since their appetites vary. Your baby’s pediatrician or cardiologist will weigh your baby with each office visit on the same scale, usually once a month. These weight measurements will show how well your baby is growing.
How To Feed Your Baby
Before your baby was diagnosed with a heart problem, you may have already decided to either breast- or bottle-feed. Both these methods work well for babies with heart problems, but it’s important to be flexible about your feeding method. Some breast-fed babies may require nutritional supplements. Some babies with heart disease may also require feeding supplements of formula or breast milk through a feeding tube. These ways to feed your baby will be discussed in the next few sections of this article. Healthcare professionals will help support your decision to bottle- or breast-feed your child. Flexibility in feeding schedules and methods is important for children with congenital heart disease.
Breast-feeding Your Baby
You probably decided how you were going to feed your baby before he or she was diagnosed with congenital heart disease. You may have wondered if you’d be able to breast-feed your baby. Not only can you breast-feed, but breast milk will actually benefit your baby.
If your baby is diagnosed with a congenital heart disease either before or immediately after birth, you probably won’t get the opportunity to nurse your baby at delivery. You’ll need to start pumping your breast within the first 12 to 24 hours after birth to maintain your milk supply. You should use a hospital breast pump and pump every 2-3 hours for the first week. Once your milk supply is well established, you can decrease pumping to 4-5 times per day. You may want to consider renting an electric pump for home use . (see picture left)
If your baby needs surgery after breast-feeding has been established, you can pump your breasts to maintain your milk supply during times when your baby is hospitalized and can’t nurse.
How will breast-feeding help my baby?
Breast-feeding offers many benefits. Breast-feeding creates a special closeness between you and your baby and is the best nutrition for your baby. Breast milk is the perfect food for your baby’s growth and development needs; it’s easier to digest than formula and also contains antibodies that help your baby fight infections.
Isn’t breast-feeding too much work for my baby’s heart?
The “work” of breast-feeding is actually less than the “work” of bottle-feeding. Sucking, swallowing and breathing are easier for a baby to coordinate while breast-feeding. The amount of oxygen available to your baby is greater while breast-feeding than bottlefeeding. Your baby’s heart rate and breathing are more normal during breast-feeding. Compared to bottle-fed babies, breast-fed babies with congenital heart defects grow better.
How can I keep up my milk supply when the baby can’t breast-feed?
You’ll need to pump at the hospital and at home. If your baby is a newborn, you’ll need to pump 8 to 12 times a day (every 2 to 3 hours). If your baby is older, you’ll need to pump as often as the baby was nursing. Remember to drink at least 8 glasses of fluid a day.
How long will I have to wait before I can breast-feed?
Depending on your baby’s cardiac and respiratory status, it could be several days to several weeks after surgery before you can breast-feed. Sometimes after surgery, babies are fed through a feeding tube. Your baby can get breast milk that you’ve pumped through this tube.
What can I do if my baby falls asleep every time I try to feed him or her?
Often after surgery your baby will remain sleepy and may not seem very interested in eating. The more time you can spend at the hospital holding your baby and offering the breast, the sooner your baby will learn to breast-feed. You may need to watch for feeding cues. These are signs that your baby is ready to eat, such as body and mouth movements, eyes opening and bringing hands to the mouth. Babies feed best when they’re awake but before they’re crying. Some babies need to be unwrapped and stimulated by gently massaging their feet or back to awaken them for feedings.
Will my baby need any formula supplement?
To increase your supply, nurse your baby more often. If your baby is too weak to suck or isn’t interested in nursing, you can continue to pump after offering the breast and give your baby expressed milk by bottle or tube. Your baby will be able to receive all the benefits of breast milk even if he or she isn’t breast-feeding.
Once my baby is breast-feeding, how can I tell if he or she is getting enough?
Your baby is probably getting enough milk if you’re nursing 8-12 times a day, the baby is latching on well and you can hear the baby gulping and swallowing. Your baby should have at least 6-8 wet diapers per day. A consistent weight gain will also tell you that your baby is getting enough milk.
If you have questions or need help with either pumping or getting the baby latched onto your breast, contact a lactation consultant. Before you’re discharged from the hospital, the lactation consultant will watch you breast-feed your baby to make sure it’s going well.
Formula-feeding Your Baby
Before your baby was born, you may have already decided to bottle-feed. This method may provide a little more flexibility, particulary if your child remained in the hospital for treatment after birth. Bottle-feeding also allows the baby’s father and other family members to become more active in feeding the baby. Breast-fed babies may also receive formula supplementation through bottle- feeding at home or in the hospital. Healthcare professionals will help support your decision to bottle- or breast-feed your child. Flexibility in the feeding schedule and method is important for a child with congenital heart disease.
Babies with congenital heart disease typically do best when fed more often and on a demand schedule. They tend to tire quickly during the feeding, so frequent feedings tend to work best. Initially, feeding your baby every two hours may be best, and you may find that you need to wake your baby at night several times to feed until he or she is able to tolerate a larger volume of formula less often. Some infants do best with a combination of breast- and bottle-feeding.
How much is enough?
All infants are individuals, and they vary in how much formula or breast milk they take per feeding. Try not to compare the amount of formula or breast milk your baby takes to the amount other babies take.
The goal for feeding an infant with congenital heart disease is consistent weight gain. Most babies gain 1/2 to 1 ounce of weight per day. However, babies with heart disease tend to gain weight at a much slower rate. The pediatrician and cardiologist will assess your child’s weight at each visit and make recommendations regarding the feedings at that time.
Babies with heart disease may not be able to tolerate a large volume of formula. They also tend to require more calories to grow than the average infant. Each ounce of formula or breast milk usually contains 20 calories. Your doctor, nurse or dietitian may recommend increasing the amount of calories in the breast milk or formula by adding a supplement if your infant is growing slowly. Avoid giving your infant water, because water has no calories. You may give juice to your baby after four months, but it shouldn’t replace formula. Formula or breast milk is still the best way to meet your baby’s caloric needs when solid food or juice are started, because milk has more calories than most solid foods or juices.
Choosing a Formula
Commercial formulas (Carnation Good Start, Enfamil, Similac, etc.) are made as nearly like breast milk as possible. You and your baby’s healthcare provider can decide which formula is best for your baby.
Choosing a Bottle/Nipple
There are many types of baby bottles and nipples you can buy. It may take several trials with various bottles and nipples before you find the one that works best for your baby. Some babies with heart disease have difficulty feeding from a regular nipple. You may want to find a soft type of nipple or make a larger hole in the nipple to allow the formula to flow more readily. Small holes in the nipple make it harder for your baby to suck and he or she may swallow air, which may result in vomiting. You can enlarge the hole in the nipple by inserting a sterilized sewing needle into the hole and “tearing” the hole open a little. The nipple should then be boiled for about five minutes in a pan on the stove and allowed to cool completely before it’s used.
Some babies with congenital heart disease may not take in adequate amounts with breast-feeding or bottle-feeding alone. These children may require additional feeding using a nasogastric (NG) tube. This nasogastric tube is placed in the baby’s nose and passes to the stomach, and formula or breast milk is delivered through the tube. This makes the feedings go easier and also requires your baby to gain more weight. Other methods of tube feeding include gastrostomy tube (GT) or jejeunostomy tube (JT). These methods involve placing the tube surgically into the stomach (GT) or intestine (JT). Your healthcare team will determine the best method and feeding schedule for your baby and you
Starting on Solid Food
Your doctor will help you determine when solid food should be added to your baby’s diet, usually around six months of age. Cereals fortified with iron are typically introduced first, followed by fruits and vegetables, and then meats.
At this time, your baby is ready to start taking cereal from a spoon. Solid food should always be fed to your baby with a spoon. Adding solid food to the formula in the bottle thickens the feeding and makes it hard for your baby to suck it.
Gradually increase the texture of food offered from pureed to lumpy, and then offer small pieces of soft table food. By 9-12 months of age, your child should be able to finger-feed soft table foods. Continue breast milk or formula at least until one year of age. Then cow’s milk can be safely introduced.
Parents sometimes think that children with congenital heart disease need to eat special diets that are low in fat, similar to low-fat diets recommended for adults with heart disease. In fact, since children with congenital heart disease often have poor appetites, high-calorie foods and snacks can play a very important role in providing good nutrition. Don’t restrict fat in the diet, particularly in the first two years of life. It’s needed to help children grow and develop properly. That’s why lower fat milks — 2%, 1% or fat-free [skim] — aren’t recommended until children are two years of age or older.
Heart Medicine and Feeding
Many babies with congenital heart disease are given medications such as digoxin (Lanoxin) and furosemide (Lasix) to control congestive heart failure. These medications typically don’t interfere with feedings. It’s usually best to give medications to your baby before a feeding. Give the medications directly into your baby’s mouth using a syringe or dropper from the medication bottle. Don’t mix any medication in the bottle of formula because your baby may not finish the formula. If the baby vomits after the medication, don’t give that medication again until the next scheduled time.
If your baby is receiving a diuretic (example, Lasix), your cardiologist may recommend a potassium supplement, because some diuretics remove potassium from the body along with the excess fluid. The potassium supplement is usually given as a liquid medication added to a small amount of juice or milk to mask the bitter taste. Foods such as bananas, orange juice, potatoes and dried fruits are also a good source of potassium for older infants. Some diuretics, such as Aldactone, prevent potassium loss and also may be given to your child.
Contact your cardiologist or other healthcare provider if your baby becomes ill, feeds poorly or vomits more than 2-3 feedings per day. Your baby’s medication may need to be adjusted or a formula change may be needed.
Ways To Boost Calories
Babies with congenital heart disease may require more calories per day than the average infant. Some babies can’t eat or drink enough formula to grow. If your baby gains weight too slowly and can’t tolerate an increased volume of formula, your doctor may recommend increasing the amount of calories per ounce. Your pediatrician, nurse or dietitian can prescribe ways for you to concentrate or fortify formula or breast milk. There are many ways to increase the caloric content of breast milk or formula. Your health-care provider is the best resource for working with you to find the best feeding strategy for your infant.
Persistent and loving efforts to feed your baby will be rewarded. Even when your baby doesn’t eat with enthusiasm, just being physically close to you during feeding times is important. Feeding your baby should be a positive experience — never a battleground.
Let your baby decide when he or she is full. If your baby doesn’t grow normally because of heart disease, heart surgery can result in a faster growth rate, with a catch-up period in height and weight. Children with heart defects often reach satisfactory growth by the time they become adolescents. Many books on infant nutrition can help you with additional feeding techniques (see Appendix I). If you have feeding problems or questions about your baby’s growth, talk with your pediatrician, cardiologist, nurse or dietitian.
Appendix I: Reference List
Combs, V.L. & Marino, B.L. (1993). “A comparison of growth patterns in breast- and bottle-fed infants with congenital heart disease,” Pediatric Nursing, 19(2), 175-179.
Lawrence, R. (1994). Breast-feeding: A Guide for the Medical Profession, 4th ed., St. Louis, Mosby.
Matthew, O.P. & Clark, M. (1985). “Breathing patterns and ventilation during oral feeding in term newborn infants,” Journal of Pediatrics, 106, 810-813.
Meier, P. (1988). “Bottle and breastfeeding: Effects on transcutaneous oxygen pressure and temperature in preterm infants,” Nursing Research, (37) 1:36-41.
Mohrbacher, N. & Stock, J. (1991). The Breastfeeding Answer Book, Schaumburg, IL, La Leche League International.
Pryor, K. (1991). Nursing Your Baby. New York: Pocket Books.
Renfrew, M., Fischer, C. & Arms, S. (1990). Breastfeeding: Getting Breastfeeding Right for You. Berkley, CA: Celestial Arts.
Satter, E. (1986). Child of Mine; Feeding With Love and Good Sense. Palo Alto: Bull Publishing Co.
Satter, E. (1987). How to Get Your Kids to Eat…but not too much. Palo Alto: Bull Publishing Co.
Appendix II: Pumps
Each of these companies makes a variety of manual, battery and small electric pumps. These pumps may be purchased, and hospital-grade pumps can be rented.
Electric pump rental is recommended for long-term use. It is most efficient to help your milk come in and to maintain your supply.
For more information, call:
Appendix III: Examples of High-Calorie Baby Foods
In addition to baby cereal and formula in your baby’s diet, these strained baby foods are higher in calories and can help boost calories.
B = Beech-Nut (stage 2) G = Gerber H = Heinz
Bananas with Tapioca (G,H) 110
Bananas with Pears and Apples (B) 100
Mango with Tapioca (G) 100
Mango, Bananas and Passion Fruit (G) 100
Peaches, Mango with Tapioca (G) 100
Prunes with Tapioca (G,H) 115
Prunes and Rice (B) 110
Beets (G,H) 60
Creamed Corn (B,G,H) 80
Creamed Spinach (G) 60
Mixed Vegetables (G) 60
Peas (G) 60
Sweet Potatoes (G,H) 80
Chicken (with chicken broth) (G,H) 110
Ham (G) 90
Lamb (with lamb broth) (H) 90
Turkey (with turkey broth) (G,H) 100
Veal (with veal broth) (H) 92
Beef Dinner Supreme (B) 130
Ham with Vegetable (G) 100
Macaroni and Beef Dinner (B) 100
Turkey Dinner Supreme (B) 110
Turkey with Vegetable (G) 100
Vegetable Bacon (G) 100
Vegetable Lamb Dinner (B) 100
Apple, Peach & Strawberry Dessert (B) 100
Banana Pudding (B,H) 100
Banana Pineapple Dessert (B) 110
Cottage Cheese with Pineapple Dessert (B) 130
Dutch Apple Dessert (G,H) 100
Fruit Dessert (G) 100
Hawaiian Delight (G) 120
Peach Cobbler (G,H) 100
Vanilla Custard Pudding (B,G) 100
Other ways to boost calories include:
Add 1 teaspoon of margarine or 1 teaspoon of vegetable oil to 1 jar of a vegetable, meat or dinner. This can also be added to table
Add 1 teaspoon of polycose or 1 teaspoon of sugar or 1 teaspoon of corn starch to 1 jar of fruit, dessert or table foods.
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