Breastfeeding

We enthusiastically recommend breast feeding for our newborn patients beginning shortly after birth. The American Academy of Pediatrics recommends exclusive breast feeding for the first 4-6 months of an infant’s life. This means your baby needs no additional foods (except Vitamin D) or fluids (including water) unless medically indicated. Then a diet of solid baby foods along with breast feeding is recommended until one year of age. Many women choose to breast feed their child much longer than this. The World Health Organization recommends breast feeding for the first two years of a child’s life. 

Breast milk has many advantages over formula feeding. Some of these advantages include:

1. optimal nutrition. Breast milk provides the nutrients in the perfect amounts that your baby needs in order to grow optimally.
2. enhanced cognitive function of the child.
3. providing anti-infectious factors to the baby from the mother.
4. decreased inflammatory conditions in the infant such as asthma.
5. the establishment of a healthy intestinal microbiome in the child.
6. the establishment of strong emotional ties between the mother and infant which yields strong emotional health for the baby.
7. cost savings (as much as $6,000 per year).
8. ease and convenience of food preparation. 

 Breast milk is the most nutritionally complete food that is available for babies. We find that the composition of breast milk is WONDERFULLY COMPLEX!  Besides the basic sugars, protein, fats and micro-nutrients that are specially designed for babies, breast milk is rich in anti-oxidants needed for eye health, rich in omega 3 fatty acids needed for healthy brain development, rich in MFGM (Milk Fat Globule Membrane) which helps support your baby’s cognitive development, rich in oligosaccarides (complex sugars) which are needed for the building of a healthy intestinal bacterial micro-flora, rich in Lactoferrin which ensures the infant’s absorption of iron from breast milk and protects against certain GI infections, and rich in nucleotides which helps build the immune system and promote cell growth. These nutrients are in the right concentrations and presented to the baby in the right form for maximum growth. 

Although the composition of infant formulas have come a long way since the time of PET milk and karo syrup, attempts to copy breast milk fall short. Simply put, breast milk is a natural food that is perfectly designed for your baby.

Breast milk contains several different anti-infectious factors which protect your child from infections. Breast fed babies are sick less often than formula fed babies. If infections do happen, they are generally milder than what they would have been if the baby was not breast fed. We routinely find that when a mother weans her baby, infections usually begin shortly thereafter.

Breast feeding also promotes closer emotional bonds between the mother and the baby. Most breast feeding mothers feel that they are giving their babies a part of themselves which helps develop more satisfying relationships. Successful infant bonding is an important factor in a mother developing an adequate breast milk supply.

There are other benefits of breast milk. It is readily available, pre-warmed and cheap. This makes middle of the night feedings easier and reduces financial stress. Infant formula can cost between $5,500 to $6,000 per year and more. 



At the time of birth, breast feeding helps the mother’s uterus contract so that less blood is lost. After birth mothers sometimes feel some mild discomfort in the lower abdomen when they feed their baby, which are the uterine contractions that breast feeding helps to stimulate. These contractions are normal. This sensation will lessen with time. 

Breast feeding utilizes about 800 calories per day of maternal nutrients, which helps a mother lose the weight that she have may have gained during the pregnancy. 

As we hope that you can see, the bottom line is this: breast feeding is the optimal way to feed your baby. The benefits to you and your baby are numerous! For these reasons, our clinic enthusiastically recommends breast feeding for all of our patients. For more information on breast feeding, please see our reading list in the back of this handbook. 

Initiation of Breast Feeding

The best time to initiate breastfeeding is within the first few minutes after birth when babies are typically alert. Most newborns will latch onto the breast soon after birth, and some may even display the “infant crawl,” instinctively moving toward the breast when placed on the mother's chest. This natural behavior, supported by instincts like rooting and nuzzling, fosters bonding with the mother and helps babies find nourishment. Skin-to-skin contact is beneficial during this time, helping regulate the baby’s temperature, heart rate, and breathing while stimulating the mother’s milk production.

Not all babies will perform the infant crawl, and various factors can affect breastfeeding initiation. Neonatal nurses play an important role in supporting these natural instincts and boosting a mother’s confidence in her breastfeeding efforts.

A few hours after birth, babies may enter a sleepy phase, feeding briefly before sleeping again. For the next two to three days, babies might be less receptive to breastfeeding, but this is normal and usually improves as their hunger increases after an initial weight loss.

Initially, breast milk is available in small amounts as colostrum. It’s normal for newborns to lose up to 10-12% of their body weight before gaining it back. This weight loss declines once the milk supply increases, typically by the third to fifth day. Early stimulation through skin-to-skin contact and frequent breastfeeding attempts can help enhance milk production and establish effective breastfeeding.

Signs indicating successful breastfeeding around the third to fifth day include: 

1. hearing the baby swallow
2. seeing milk in the corners of the baby’s mouth during feeding
3. experiencing leakage from the opposite breast at the start of breastfeeding sessions.

These signs of adequate breast milk supply should reassure mothers that breastfeeding is progressing well. 

Engorgement

Eventually, a mother’s breasts will feel heavy and tight as they fill with breast milk. If not drained adequately during these early days, engorgement can occur, which is common as milk production begins.

To manage engorgement, feed your baby frequently, ideally every 2 to 3 hours, to relieve fullness and establish milk supply. Ensure your baby is latching correctly—don’t worry if their nose touches your breast, they can breathe in this position. Before nursing, apply warm compresses or take a warm shower to stimulate milk flow and soften the breasts, aiding latching. After feeding, use cool compresses to reduce swelling and discomfort. Hand expressing, breast pumping, and massaging towards the nipple while feeding can also alleviate engorgement. Wear a supportive, non-underwire bra to prevent additional pressure on your breasts. If engorgement persists or is severe, seek medical advice at the hospital or at our office.

By the third or fourth day after birth, your breast milk should “come in,” and the baby will begin to regain lost weight. During this phase, babies may feed often due to hunger and thirst, sometimes exhibiting “marathon feedings.” or “cluster feedings.” Feed your baby on demand whenever they desire. To ensure successful breastfeeding, avoid using infant formula or bottles unless your baby loses more than 10-12% of their body weight. Supplementation with formula can cause infants to prefer bottles since formula is easier to obtain than breast milk in the first days of breastfeeding.

Bring your baby to our office on the third to fifth day of life so we can assess feeding adequacy, weight loss, feedings, jaundice, and signs of infection. We will advise on further follow-ups during this check-up.

For optimal nutrition, breastfed babies need vitamin D supplementation, as breast milk may not provide enough vitamin D3 needed for strong bones. The American Academy of Pediatrics recommends starting 400 IU (international units) of vitamin D3 daily within the first few days or weeks of life. This supplement is available over the counter. Fluoride supplementation, starting after six months, may also be necessary depending on your community’s water fluoride content. Consult us if your tap water lacks adequate fluoride, such as well water, to prevent tooth decay.

Infant Formula Feeding

Sometimes, parents choose to bottle-feed their infants using infant formula. If opting for formula, please contact our office for guidance on the appropriate choice for your child. A good formula choice for most babies is Enfamil Neuropro. We advise against changing your baby’s formula without our input. Infants should be fed iron-fortified formula for proper nutrition until they are 12 months old—all commercially available formulas in the U.S. are fortified with iron. Avoid introducing cow’s milk during the first year, as it doesn’t meet an infant’s nutritional needs. Cow’s milk contains too much protein, insufficient iron, excessive sodium, and an inadequate distribution of vitamins, minerals, fats, and calories compared to breast milk and formula.

Some infants may require specific formulas for health reasons, and switching formulas without medical guidance can be risky. Therefore, ignore formula advertisements, samples, and promotions that aim to sway your decision. The selection and use of infant formula must be under our direct supervision to ensure your child’s health and nutrition. We also typically do not recommend toddler formulas.

Formula-fed infants usually do not need additional vitamin supplementation, as the required nutrients are included in the formula. Fluoride supplementation is unnecessary if the formula is mixed with water containing enough fluoride. Most communities, including Little Rock and North Little Rock, have adequate fluoride levels in their water supply. If you have questions about fluoride content in your water, please contact your local water authority for specific information.

Four to Six Months: 

During the first four months of life, breastfeeding and formula feeding provide all the calories, water, and nutrients your baby needs. We generally recommend introducing solid foods between four to six months of age, once your child is physically ready to swallow them. Solids contain fewer calories per unit volume than both breast milk and formula. Some babies might need to begin solids earlier for specific medical reasons, such as reflux or excessive spitting up.

The goal of introducing solid foods is to gradually transition your baby to a more mature diet. Your baby’s first solid food should be an iron-fortified infant cereal. There are three types readily available: rice, barley, and oatmeal. Initially, mix one tablespoon of cereal with breast milk, formula, or water for feeding. The long-term goal is to offer four tablespoons per serving, two to three times per day, increasing the amount gradually.

The U.S. Food and Drug Administration (FDA) has raised some concerns about small amounts of arsenic naturally found in rice, which are also present in infant rice cereal. This concern does not mean you should avoid rice cereal entirely, but the FDA advises against using rice cereal exclusively. Instead, they recommend including a variety of cereals—such as rice, oatmeal, and barley—to limit exposure to arsenic found in rice. Multi-grain mixed cereals can be an option to adhere to the FDA’s recommendations.

Vegetables can also be introduced between four to six months of age, and they can be offered in any order. Some options to consider are carrots, squash, green beans, peas, sweet potatoes, and avocados. It’s often recommended to introduce vegetables before fruits to help your child develop a taste for them and avoid a “sweet tooth.”

When introducing a new food to your child’s diet, wait two to three days before trying another new food. This interval helps monitor your child for potential food allergies. Symptoms of a food allergy can include vomiting, diarrhea, bloody stools, rash, colic, irritability, and insomnia. If any of these occur after introducing a new food, discontinue it and inform us during your next office visit.

After each feeding of solid foods, continue to provide breast milk or formula. The amount of solid food your child eats should depend on their appetite. Offer as much as your child wants, but do not force them to eat when they are no longer interested. 

The next food to introduce in your child’s diet once he or she is eating a variety of vegetables is fruit. You can introduce a new fruit every two to three days. You should initially use individual fruits and not mixed fruits because of the need to identify which food your child might react to. We recommend starting vegetables first before fruits. Fruits are much sweeter and your child may prefer these over vegetables if you start them first. 

Juice is not encouraged because it causes cavities and may be associated with poor eating habits, poor weight gain and sometimes obesity. You can use up to 4 ounces of fruit juice daily to treat constipation however.

Meats are the last foods that you should introduce into your baby’s diet. They have the highest protein content and are the most difficult for the infant to digest. We generally recommend delaying meats until the child is about seven months old. You can try chicken, lamb, veal, turkey, beef, liver, pork and fish. 

Omega-3 Fatty Acids (Fish): 

Should my child and my family eat fish? The simple answer is yes! Fish provide essential nutrients that support cognitive and visual development, particularly omega-3 fatty acids—DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid)—which are hard to find in other foods. These nutrients help build strong nerve membranes, enhancing both cognitive and visual functions.

To ensure these benefits while limiting mercury exposure, consider the following FDA and EPA guidelines:

1. Quantity: Adults should consume 8-12 ounces (2-3 servings) of a variety of fish each week. For young children, aim for 2-3 servings per week, adjusting portions based on their age and calorie needs.
2. Eat Fish that are Low in Mercury: Common options include salmon, shrimp, pollock, light canned tuna, tilapia, catfish, and cod. High-Mercury Fish to Avoid: Tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel. Limit white (albacore) tuna to 6 ounces per week.
3. Locally Caught Fish: If you consume fish caught from local streams, rivers, or lakes, check for any fish advisories on safety. If no advice is available, adults should limit consumption to 6 ounces per week, and young children to 1-3 ounces, without eating other fish that same week.

Many foods, including eggs, milk, soy beverages, juice, yogurt, bread, and cereal, can be fortified with omega-3 fatty acids. However, these typically contain only ALA (alpha-linolenic acid). While ALA is beneficial to overall health, it doesn’t offer the same advantages as DHA and EPA, which are essential for cognitive and visual health in children. Most food labels do not specify the type of omega-3 provided, so eating fish, which contains DHA and EPA, remains irreplaceable. Although flaxseed is touted as a good source of omega-3s, it only supplies ALA, which supports heart health but does not boost brain health.

Some people opt for fish oil supplements to obtain DHA and EPA, as a way to avoid mercury that tends to be present in fish muscle rather than in fish oil. However, fish consumption is generally recommended for children, as it is the simplest and most effective way to obtain DHA and EPA.

Omega-6 Fatty Acids: 

The American diet is often high in omega-6 fatty acids, largely due to a shift from fresh vegetables and fish to foods rich in omega-6 fatty acids. Common sources include vegetable oils like corn, soybean, sunflower, safflower, and cottonseed oils. These are frequently used in processed foods such as chips, crackers, cookies, and pastries, as well as in fast-food restaurants for frying. Nuts and seeds, such as walnuts, sunflower seeds, and pumpkin seeds, also contain omega-6 fatty acids. Additionally, meat from corn-fed animals tends to have higher levels of omega-6 compared to grass-fed options. Margarine and shortening, often derived from these oils, further contribute to omega-6 intake.

Historically, the omega-6 to omega-3 ratio was about 2:1, but today’s American diet shifts this to at least 20:1. Arachidonic acid, an omega-6 fatty acid found in foods, is converted in the body into inflammatory substances called prostaglandins and leukotrienes. While these substances play vital roles in the immune response and blood clotting, excessive levels of arachidonic acid can lead to chronic inflammation, linked to diseases like asthma and arthritis.

Balancing omega-6 with omega-3 intake is needed for health and inflammation management. Omega-6 fatty acids are pro-inflammatory while omega-3 fatty acids are anti-inflammatory. Consuming more fish, such as salmon and sardines, can support visual and cognitive function while reducing inflammation due to its content of omega-3 fatty acids. It’s advisable to include these safer fish species regularly in your diet to help restore a healthier fatty acid balance to control inflammation and promote brain health.

Peanuts:

 In the past, flawed clinical practice guidelines from the American Academy of Pediatrics recommended the avoidance of potentially allergenic foods in the diets of very young children. Our advice at All For Kids was to follow the AAP guidelines and introduce peanuts, a highly allergenic food, into the diet of our young children at two years of age in an attempt to protect them from peanut allergy. 

Unfortunately, the strategy of delaying peanut consumption in the diet failed, resulting in actually dramatically increasing the prevalence of peanut allergy in Western countries by 2 to 3 times the former rate over the past generations. Up to 1 to 3% of all US children have had peanut allergy, the highest rate ever. Peanut allergy is the leading cause of food allergy related death in the United States. Schools have strived to be peanut free as a form of safety for peanut allergic children. The entire strategy of peanut avoidance has been misguided and actually harmful to our population.

Research on Peanut Allergies: 

Researchers in the United Kingdom noticed something interesting about the incidence of peanut allergy in differing populations. Peanut allergy in Jewish children living in the UK was about 10 times more common than it was in Jewish children living in Israel. Since these children shared a similar ancestry, the researchers reasoned that the difference had to be something that those children were doing differently. 195 

It turned out that their diet was the difference. Jewish children in the UK rarely ate peanut products in the first two years of life, whereas children in Israel commonly ate a snack food called Bamba. Bamba is a corn puff made with peanut butter. Could this have been the difference? Israeli children ate peanut products from an early age and somehow this protected them from peanut allergy. So the researchers tested it. 

The Learning Early About Peanut Allergy (LEAP) study, supported by the National Institute of Allergy and Infectious Diseases (NIAID) and conducted by the NIAID-funded Immune Tolerance Network (ITN), tested the theory that the very low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption from a young age. They did a study of about 640 babies who had severe eczema and/or egg allergy, which are known to increase the risk of peanut allergies. They divided the children into two groups: one was given Bamba to eat regularly. If they didn’t like Bamba, they could eat smooth peanut butter. 

The other group was told to stay away from foods containing peanuts. They did this until the children were 5 years old. Researchers found that exposing infants to peanuts in their first year of life helped prevent peanut allergy by as much as 81 percent. The LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage this serious public health problem. Thus, most peanut allergies can be prevented by feeding children food containing peanuts at an early age.

So, what should we do in response to this information? In 2017 we at All For Kids Pediatric Clinic began recommending that young children be fed peanut products at an early age. Now, peanut allergy is very rare in our All For Kids pediatric population since 2017! 

How to introduce peanuts into the diet of infants:

We recommend introducing peanuts into the diet of infants to reduce the risk of developing peanut allergies. Infants at low allergy risk (without eczema or other food allergies) can usually start consuming peanuts around 4 to 6 months of age, after they’ve begun eating other solid foods. The infant should show readiness for solids, such as the ability to sit up, to minimize choking risks. Peanut butter flour (PB2) can be blended with applesauce or infant cereals and given to the child. A good recipe is 2 teaspoons of PB2 mixed with 2 tablespoons of applesauce. Smooth peanut butter can be thinned with warm water and mixed into various purees. Always supervise and monitor the infant for any allergic reactions when feeding peanuts for the first time. Allergic reactions such as swelling, hives, or breathing difficulty should prompt seeking medical attention right away.

For infants with mild to moderate eczema, introducing peanuts during the usual 4- to 6-month window is also encouraged, ideally under professional guidance. This proactive approach intends to build tolerance while ensuring safety. Consult us with such infants before feeding them peanut products. 

Whole peanuts or pieces should not be given to children under the age of 4 due to choking hazards. Instead, spread creamy peanut butter thinly on crackers or bread, or use it in foods. Some parents introduce peanut butter by letting the child suck it off a finger. However, the easiest way to introduce peanuts is to mix peanut flour (PB2) with applesauce.

One Year and Older: 

The first year of life is your child’s period of most rapid growth. After about 12 months, the rate of growth decelerates and parents notice that the child’s appetite decreases. Many times, parents become very concerned that their one-year-old child seems to be eating less. Part of your health supervision visits is to actually plot the height, weight and head circumference of your child on a growth chart. As long as his/her growth percentiles are within the normal range and the blood count is normal, you can be assured that your child is receiving adequate nutrition.

 After the age of 12 months, usually breast feeding and/or formula feeding is discontinued and cow’s milk  is introduced into the diet, although it is fine for breast feeding to be continued after 12 months. The World Health Organization recommends breast feeding until two years of age. 

If breast feeding is not chosen after 12 months, whole milk is recommended up to age two, because children need the extra healthy fats in the diet for brain development. Your child can be switched to a low fat milk at 2 years of age. Kids who are at risk of becoming overweight can be switched to lower-fat milk before turning two.

 It is a good idea for young children to have mealtimes at regular hours each day. Sharing meals at the family table is important. Children should eat a balanced diet from all food groups. You should nor force your child to eat food he does not want. Simply make foods available to your child. At 12 months of age, we also like to encourage parents to discontinue the use of a bottle and offer their children beverages in a cup.

Lastly, the timing of milk and fruit juice consumption is crucial in preventing tooth cavities in young children. Drinking milk or juice before bedtime can lead to cavities, often called “milk cavities.” This occurs because sugars in these beverages feed bacteria (such as alpha Strep viridans) in the mouth, causing them to produce acid that erodes tooth enamel.

To prevent cavities, avoid giving your child any sugary drinks, including milk, fruit juice, and sodas, within 30 minutes of bedtime. It is also important to brush your child’s teeth at least 30 minutes before bed and to ensure no sugary beverages are consumed after brushing.

Preventing cavities is vital because a single cavity gives bacteria a foothold, leading to more cavities over time. This advice also applies to nap-times, ensuring good dental hygiene and habits throughout the day.

Vitamin supplementation  after the first year of life is usually not needed as long as the child is eating a well balanced diet from all of the food groups. If this is not the case, then a multivitamin with iron is probably a good idea. Fluoride supplementation for the older child is needed only if the water supply contains inadequate amounts of fluoride.

The Picky Eater: 

Many parents in our practice express frustration with their toddlers’ and young children’s picky eating habits. Some children consume a limited and unhealthy diet, often grazing on snack foods like crackers, cereal, and cookies, which ruins their appetite. Additionally, picky eaters may drink excessive fruit juice or milk, which limits their intake of healthier options, such as vegetables and fruits.

This pattern is unhealthy because it can lead to nutritional deficiencies, obesity, or malnutrition, and these habits can persist into adulthood. It is crucial to change your child’s eating habits.

A natural remedy for picky eating is simply allowing hunger to motivate better eating habits. Offer your child balanced, nutritious meals from all food groups three times a day. If they eat well, a snack between meals is acceptable. If they refuse a healthy meal, offer only water until the next meal.

Initially, your child may throw a temper tantrum when expected snacks or drinks are withheld. Ignore the tantrum and continue withholding food or juice until the next mealtime. After missing one to three meals, most children adapt and start eating more healthy. Going without food for a day will not harm a normal child, but ensure they have enough water and that healthy food options are provided.

This approach teaches discipline, which is essential for developing healthy eating habits in children.

Nutritional Deficiencies

Sometimes children go past mere pickey eating, and develop malnutrition, a serious, very complicated medical condition. Malnutrition arises from various deficiencies, impacting a child's growth, development and overall health. 

Protein-calorie malnutrition can stunt growth and delay development. It manifests in two primary severe forms: kwashiorkor, which is characterized by edema, an enlarged liver, and rashes due to insufficient protein intake; and marasmus, marked by severe wasting and weight loss due to an overall calorie deficiency. Chronic infections, gastrointestinal diseases, and inappropriate feeding practices may cause or exacerbate the problem. Any such child needs to have an appointment in our office with one of our physicians to discuss the problem ASAP.

Addressing nutritional deficiencies requires a multifaceted approach. To prevent this problem, encourage diverse and balanced diets rich in vegetables, fruits, whole grains, proteins, and dairy or plant-based alternatives. Supplemental vitamins and minerals may be necessary for children with restricted diets. Part of our job is educating parents and caregiver