Formula Feeding Your Baby

Let’s really go back to the very beginning and review some basics of baby formula preparation.  Of course, we pediatricians still advise that the best infant nutrition is breastfeeding, but at some point most babies’ diets will likely include some formula.   The AAP recommends the following:

  1. Prepare the formula according to the manufacturer’s directions ONLY.  DO NOT dilute the formula (to save money) or concentrate it (to increase calorie concentration).  Both can cause diarrhea at least and sometimes disruption of blood electrolyte levels like sodium and potassium which can lead to severe problems with normal nerve or heart function.
  2. Make sure the water source is safe.  If your home has well water, it’s best to boil the water for 1 minute (“rolling boil”) and then allow 30 minutes to cool before mixing your formula.
  3. Be careful to maintain proper formula temperature.  Use a bottle warmer or place the bottle in a container of hot water for 5-10 minutes.  It is best not to microwave the bottle.  Microwaving can heat the insides of any container in an uneven fashion which can cause burns, and also it can disrupt the nutritional value of some formula ingredients.  At any rate, its best to always check the formula temperature on yourself prior to giving it to the baby.
  4. “Cleanliness is next to Gdliness.”  Always wash your hands prior to preparing or feeding your baby.  Wash all countertops and surfaces carefully.  A dishwasher will not clean the inside of a long, thin bottle very well, so wash by hand using a bottle brush for the inside.  Bottles and nipples should all be cleaned with hot, soapy water and be sure to rinse all soap off thoroughly.  By the way, best to boil nipples for approximately 10 minutes prior to using for the first time.  This is not for cleanliness as much as to boil off residue of chemicals used to soften the rubber.
  5. Be aware of proper storage times.  All leftover formula should be discarded 1 hour after feeding to the baby.  Powder based preparations can be refrigerated for 24 hours; bottles of unused concentrate can be refrigerated for 48 hours prior to usage.

As stated initially, breastfeeding is still best and what I and all pediatricians recommend as the first line nutritional source for your baby’s best health.  This seems like a good place for me to give a shout out to Dr. Rose St. Fleur and my colleagues at the Center for Breastfeeding at Jersey Shore Medical Center.  They can be reached at 732-776-3329 and are an excellent resource/clearinghouse for questions from nursing mothers.  Tell them Dr. G sent you (they won’t care).

Thanks for following.

Hand Foot and Mouth Disease

Hand foot and mouth disease (HFMD) is a well known and common illness. Let’s review.

Curiously, when I was a resident, this was mostly a summertime/early fall illness, but now I diagnose it almost year round.  I do not have a good explanation for that development.

HFMD was first identified in 1957 in New Zealand and Canada.  Initially, due to the mouth blisters,  HFMD was assumed to be caused by herpes virus, which explains one of its common names–“herpangina.”  However, we now know that it is caused by a different virus, called “coxsackie.”  This is a member of the “enterovirus” family, which means that its a GI virus and spread via hand/mouth contact from body fluids–not from “droplet” contact like from coughing and sneezing. Therefore lets note that best preventive measure is careful hand washing, as well as cleaning home surfaces and toys.  Many different strains of coxsackie can cause HFMD which explains why we keep seeing kids getting it year after year, and why your child can get it multiple times. HFMD incubates for 3-5 days after exposure, then may cause symptoms like fever, white or red spots in the mouth, throat, or lips as well as blister like lesions on the palms and soles and red spots on the rest of the body.  Any combination of the above is possible–a child does not have to have all of the above to have an HFMD coxsackie infection. Spread in public or nursery schools, day care/babysitting centers is universal.

HFMD can be sporadic, but I very typically see it in epidemics: when one case comes in I expect to be inundated.  Epidemics as large as 1.5 million cases are not uncommon.  Most infections occur in children < 10 years old.  Symptoms may last 7-10 days but generally resolve in < 1 week.  There is no specific treatment to shorten its course.  Use acetaminophen or ibuprofen for pain or fever. Cold compresses like ice pops are very helpful.  Honey or topical treatments like Abreva or Blistex can relieve the sore throat pain.  The only common complication is dehydration due to poor fluid intake caused by pain from numerous mouth lesions.  Those children may require ER or admission for IV fluids, but again, they almost always recover nicely.  There are numerous more severe but rare complications which have been reported.  In 33 years of practice I have never seen one personally, so there’s no reason to list them here just to make you folks nervous.

One last point.  HFMD affects children.  “Hoof and Mouth” disease infects cattle and is a completely different problem.  They have nothing whatsoever to do with each other.

Please send along questions or comments, and thanks for following.