While feeding your baby provides nutrition for physical and mental growth, it is also an opportunity for you to love, touch and communicate with your child. When your baby gains weight steadily and is content and thriving, it's reassuring and rewarding. A baby born with a congenital heart defect (CHD), however, may not gain weight as rapidly as other infants, despite your hard work and persistence. At times this may be frustrating.
Your baby's growth
Healthy babies usually double their birth weight between 3 and 4 months of age. Infants and children with congenital heart disease tend to gain weight more slowly. The most common reason for poor growth is that the baby isn't taking in enough calories or nutrients. Infants may get tired while feeding and therefore take in less food. If your baby seems to drink enough breast milk or formula, he or she may still gain weight very slowly due to the increased caloric needs. Your baby's pediatrician or cardiologist will weigh your baby with each office visit. These weight measurements will show how well your baby is growing.
How to feed your baby
Breast feeding is the best source of nutrition for most infants. It can also reduce the risk of certain health conditions for both mother and baby, but it's important to be flexible about your feeding method and schedule. Some babies with heart disease may also require feeding supplements to their breast milk or formula or require feeding through a feeding tube placed into the nose.
Babies with congenital heart disease typically do best when fed more often and on demand. They tend to tire quickly during feeding, so frequent feedings tend to work well. Initially, you may need to feed your baby every one to three hours, and you may need to wake your baby several times during the night for feeding until he or she is able to tolerate a larger volume of milk.
Breastfeeding your baby
If your baby is diagnosed with a congenital heart defect either before or immediately after birth, you probably won't get the opportunity to nurse your baby at delivery. If this is the case, it’s recommended that you use a breast pump to express milk within the first six hours after delivery. Then continue with at least eight sessions per 24 hours. As your baby progresses, be sure to pump as often as your baby is feeding to maintain your supply. You may want to consider renting an electric pump for home use. If your baby needs surgery after breastfeeding has been established, you can pump your breasts to maintain your milk supply during times when your baby can't nurse. Be sure to clean your breast pump before and after each use.
How much and how often babies feed will depend on their individual needs. The first few days they may feed every one to three hours. During the first weeks and months they will feed about every two to four hours. Although this may vary at times with shorter or longer times between feedings, generally they will feed eight to 12 times in 24 hours.
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 breastfeed your baby to make sure it's going well.
Formula-feeding your baby
Formula feeding may provide a little more flexibility than breast feeding, particularly 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.
Commercial formulas, available at most supermarkets, are regulated by the Food and Drug Administration and must meet minimum nutritional and safety standards. You and your baby's health care professional can decide which formula is best for your baby. Be sure to wash your hands and bottles and properly prepare the formula when making up a bottle. During the first few days start by offering one to two ounces of formula every two to three hours. As your baby gets older you can start to increase the size of the bottle and continue with feedings every three to four hours. Babies will generally take what they need.
There are also many types of baby bottles and nipples available. You may need to experiment to find the best nipple for your baby. An occupational therapist, clinical nurse specialist or feeding team member may assess your baby's feeding habits and make recommendations for a specific feeding schedule and nipple.
Some babies with congenital heart disease may not take in adequate amounts of calories with breastfeeding or bottle-feeding alone. These children may require additional feeding using a nasogastric, or NG, tube. This NG tube is placed in the baby's nose and passes to the stomach. Formula or breast milk is delivered through the tube. This makes the feedings less "work" and results in your baby gaining more weight. Other methods of tube feeding include gastrostomy tube (G-tube) or jejunostomy tube (J-tube). These methods involve placing the tube surgically into the stomach (G-tube) or intestine (J-tube). You and your child’s health care team will determine the best method and feeding schedule for your baby.
Avoid giving your infant other liquids until they are 6 months old. Formula or breast milk is the best way to meet your baby's caloric needs when solid food or juices are started.
Starting on solid food
Your doctor will help you determine when solid food should be added to your baby's diet. This usually occurs around 6 months of age. For most children you don’t need to give foods in a certain order. Foods to introduce may include fortified cereal, fruits, vegetables, proteins, grains, yogurt and cheeses. These foods are soft and easier for the baby to eat. This is the time to build healthy eating habits with your child. Talk with your pediatric health care team about the best foods to introduce based on your child’s specific growth curve.
Heart medicine and feeding
Many babies with congenital heart disease are given medications such as furosemide 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. Do not mix any medication in the formula bottle because your baby may not finish the bottle. If the baby vomits after the medication, do not give that medication again until the next scheduled time.
Contact your cardiologist or other health care professional if your baby becomes ill, feeds poorly or vomits more than two to three feedings per day. Your baby's medication may need to be adjusted, or a formula change may be needed.
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 satisfied. If you have feeding problems or questions about your baby's growth, talk with your pediatrician, cardiologist, nurse or dietitian.