Child Health Information - Children`s Health Queensland

Child Health Information - Children`s Health Queensland
Children’s Health Queensland Hospital and Health Service
Child Health
Information
Your guide to the
first 12 months
Contents
Introduction..................................................................................... 2
Common breastfeeding concerns............................ 49
Bonding................................................................................................ 4
Sleepy or unsettled baby............................................................. 49
Common early problems — tender or cracked nipples....51
Swollen breasts, blocked ducts, mastitis............................ 52
Breastfeeding when you are working
or away from your baby................................................................. 54
When do I stop breastfeeding?.................................................. 57
Drugs and breastfeeding............................................................. 59
Keeping your baby safe........................................................ 5
Safety advice for you and your baby.......................................... 5
Safe sleeping......................................................................................10
Immunisation..................................................................................... 13
How your baby develops................................................... 14
0–3 months........................................................................................ 15
3–6 months........................................................................................ 18
6–9 months........................................................................................ 22
9–12 months...................................................................................... 27
Taking care of your baby’s teeth............................... 32
Taking care of your baby's ears.................................. 34
When your child is sick....................................................... 36
Breastfeeding............................................................................. 39
Best for baby and for Mum.......................................................... 39
Getting started...................................................................................41
How do I start a breastfeed?....................................................... 44
Is my baby getting enough milk?.............................................. 47
Formula feeding........................................................................64
Bottle feeding.................................................................................... 64
Introducing solids...................................................................68
When and why................................................................................... 68
Food allergies.................................................................................... 68
Feeding from around 6 months................................................. 70
Feeding from 7 to 12 months..................................................... 72
Feeding from 12 months............................................................... 75
Recipes for babies........................................................................... 79
Solids guide........................................................................................ 84
Physical Activity....................................................................... 85
No screen-time.................................................................................. 86
Sun protection................................................................................... 86
Acknowledgements............................................................... 87
Notes...................................................................................................88
1
Introduction
Congratulations on the birth of your baby!
Personal Health Record
This booklet has been produced by Queensland Health
to help answer some of the common questions parents
and carers have about caring for their baby.
Your Personal Health Record ("red book") is essential for
keeping your child's records of health, growth,
developmental checks and immunisations. There are also
sections for you to fill in to help your health care provider
better understand your child.
It covers the stages of your baby’s development from
birth through to his or her first birthday, plus guidance
on feeding your growing baby.
Research has shown that a healthy start in life — including
good nutrition, a safe and secure environment, a warm
and loving relationship with parents and carers, talking,
singing and playing in the first year — is the stepping
stone to a healthy life, right through to adulthood.
Remember, if you would like more information about your
child’s development, health or nutrition, contact your
child health nurse or your doctor.
The list of emergency and helpful numbers at the back
of this book will also point you towards further help.
Enjoy your first year of parenthood!
Registering your baby’s birth
2
Your baby's birth must be registered with the Registry of
Births, Deaths and Marriages (BDM). You will not be able
to get a birth certificate until this is done. For more
information see the back of the first tab in your child's
PHR or visit BDM’s site at www.qld.gov.au/births.
Take it with you whenever you take your child to any
health care provider so they can record the visit, and so
other health care providers can see your child's health
check and immunisation history.
Child Health Nursing Service
Child and family health nurses are registered nurses with
postgraduate qualifications and experience in child and
family health nursing. Many child health nurse hold
qualification in midwifery, and may be lactation
consultants and have extensive paediatric experience.
They are able to support families with key health
promotion interventions for children and families as well
as evidence-based prevention, health education and
anticipatory guidance.
To find your nearest Child Health Clinic, search at
www.qld.gov.au/health/children or call 13HEALTH
(13 43 25 84)
* If you are having difficulty connecting it may be useful to dial 13 HEALTH
using only the first six digits of the phone number (13 43 25). If you are still
unable to connect to 13 HEALTH then please contact your service provider
to discuss the issue.
Parents' Evaluation of Development Status
(PEDS)
As a parent you know your child better than anyone else
does. You may notice things about your child that concern
you – perhaps even things that no one else has noticed. It
is important that you share these with your health care
provider. Research shows that sharing your concerns
about your child can help your health care provider
understand your child better, and may also help pick up
any problems early. PEDS is a set of 10 tested and reliable
questions that are included at 6, 12, 18 month, and 2½
–3½ and 4-5 year visits.
Please answer the questions in your Personal Health
Record book before each designated health check and
discuss them with the health care provider during that
health visit to help them better understand your child.
The first 5 years last a lifetime
Research shows that up to 90% of a child's brain
development happens in the first 5 years. First 5 Forever
supports you to share stories and make talking, reading
and singing part of your daily routine. Visit your local
library for free resources and activities for you and your
baby to enjoy together, and for more ideas and
information visit www.first5forever.org.au.
Playgroup
Playgroup Queensland provides opportunities for every
child to learn through quality play experiences while
supporting parents and carers in their role as first
teachers. Find them on Facebook: Playgroup Qld.
Importance of kindy
It’s never too early to enrol your child in kindy. There is
extensive evidence-based research demonstrating that
children's education and care affects their health,
wellbeing and competence throughout their lives. A
Queensland Government-approved kindergarten program
positively assists children with their emotional, physical,
social and intellectual growth and development.
Beyond the first 12 months
For information and factsheets on topics beyond the first
12 months, visit the Raising Children Network site at
www.raisingchildren.net.au.
3
Bonding
Bonding with your baby
For many parents, connecting emotionally with their baby
already started during pregnancy. However the
opportunity for parents and their baby to really get to
know each other and build a relationship begins after
birth. This is known as bonding and attachment.
Here are some tips for this time.
• Remember that babies love faces and eye contact.
Spend lots of time sharing loving eye contact with your
baby, while being sensitive to when they need a break
and may look away. Stay connected with them until
they turn their attention back to you. For example,
comment saying “This is hard work, you are getting
tired, I will wait until you are ready”.
• Babies thrive on parents’ love and attention and enjoy
lots of positive touch in these early days. Some might
say “you will spoil the baby” but this is impossible
when you are responding to your baby’s needs.
• When your baby is upset, try to understand what this
may be like from their point of view and do what you
can to comfort them.
4
• Talk to your baby often and try to put what your baby is
feeling into words. For example, “You’re so happy to be
playing this game” or “Oh, it’s so sad to be hungry/
wet/lonely”.
• Name actions that you are doing e.g. when dressing
baby "One arm through, other arm, over you head !"
Over time, this helps babies learn to predict what is
happening next
• Enjoy your baby while following their lead. This will help
you both to build a sensitive relationship. For example,
if your baby grabs a new object, sit near them and
describe it.
• Not everyone falls in love with their baby immediately;
relationships build over time. Trust your own feelings and
make sure you get support from family and friends or see
a health professional if you feel like something is not right.
The baby's brain undergoes incredible development in the
first 1 to 3 years of life, so the experiences of a baby’s first
three years are critical to their physical, social and
emotional progress. That is why a baby needs warm,
responsive, nurturing care from caregivers – it is through
these relationships that a baby learns to become who
they are. For more tips see http://raisingchildren.net.au/
articles/connecting_with_your_newborn.html
Looking after a new baby can be very demanding. Getting
help early from family or professionals such as the GP or
Child Health Nurse if parents experience distress, anxiety
or depression can help to prevent the development of
more serious issues for parents and the relationship with
your baby. For more information on this, see the Beyond
Baby Blue website at www.beyondblue.org.au/resources/
for-me/pregnancy-and-early-parenthood
Keeping your baby safe
Safety advice for you and your baby
Injury is the leading cause of death among Queensland
children.
Queensland has one of the highest mortality rates for
childhood injury in Australia. Unfortunately, the home is
the most common place for children’s injuries to occur.
As you care for your baby and watch them grow, keep
alert to all the ways children can unintentionally hurt
themselves. The most common injuries are falls, drowning
(and immersions), burns and scalds, and poisonings.
It is important to realise that accidents are not inevitable
and, in fact, that most accidents can be predicted and
prevented.
The aim is not to wrap children up in cotton wool. After all,
exploring, taking risks and trying new things are all crucial
parts of children’s development. However, it is important
to know where your child is at all times and what they are
doing.
To download a comprehensive child home safety
checklist, visit www.health.qld.gov.au/ph/documents
and search 'home safety checklist'. Reuse this checklist
each year as your child grows, develops and explores.
Further safety tips can be found at the Kidsafe website:
www.kidsafeqld.com.au.
Caring for your baby
• Never leave your baby alone on change tables, chairs,
beds, tables, chairs or other high furniture.
• Hold your baby when feeding them a bottle, rather than
propping them up. Babies can vomit or inhale milk and
holding your baby in an upright position will decrease
the risk of ear infections and infant tooth decay.
• Do not heat your baby’s bottle in a microwave oven.
The milk can heat unevenly, risking scalding your
baby’s mouth.
• Never handle hot food or drinks, such as tea, coffee or
noodles, while holding your baby. Burns from hot water
and drinks can cause severe scarring to children.
• Make sure all caregivers are aware that a baby should
never be shaken as this can cause brain damage or
death.
• Keep your baby out of direct sunlight. Use sun
protection methods, including: shade when possible,
SPF30 or higher water resistant sunscreen, clothing
that covers as much skin as possible and a broad brim/
bucket or legionnaires style hat. Sun protection
information for infants is available from Cancer Council
Queensland on 131 120 or www.cancer.org.au.
5
Keeping your baby safe
Safety advice for you and your baby (continued)
Toys
Clothes and dummies
• Toys must be safe, durable and washable. If a toy
is furry, remember babies can suck on the fur and
swallow it.
• If your baby has a dummy, check it:
• Toys should not have:
-- is in good condition
-- has no ribbons or chains
-- dangling ribbons, long strings or elastic
-- has holes in the plastic holder for quick,
easy removal in an emergency
-- small or loose parts that can be pulled or chewed
off
-- is only used to settle your baby and not put them
to sleep.
-- squeakers that can be removed
-- sharp edges or points
-- rattles that can be taken apart
-- button batteries.
• Make sure teething rings can’t be pierced.
• All cuddly toys should be stuffed with old stockings,
dacron or polyester. (Crumbled foam, beans and beads
can all be swallowed or pushed into ears or noses.)
• The use of a dummy after six months of age can
increase the risk of ear infections and associated
hearing loss.
• Remove any loose ribbons or trimmings on clothing
because they can choke your baby.
• Look inside mittens and bootees to make sure there
are no loops or threads that can wind around your
baby’s fingers and toes because they can cut off
circulation.
• Remove all head covering before placing your baby
to sleep as they may overheat or become entangled.
6
Bath time
• Always check the temperature of the water with your
wrist or elbow before putting your baby in the bath.
• Never leave your baby alone during bath time —
not even for a minute.
• Babies should never be left in the care of older children,
no matter how reliable they seem.
• Check that your home has a properly functioning hot
water tempering device installed and set at the right
temperature (50°C).
Around your home
Your baby is very mobile and eager to explore. Check
your house thoroughly and often to keep your baby safe.
• Button batteries are in many products, they are
extremely dangerous if inserted (nose, ear) or
swallowed. Identify items with button batteries in
them, secure the battery compartment, keep them out
of reach of children and dispose of them safely. If you
think your child has swallowed or inserted a button
battery, immediately call the 24 hour Poisons
Information Centre on 13 11 26 for fast, expert advice.
• Always ensure your baby is strapped in securely when
in a bouncer, stroller or high chair.
• Always keep one hand on your baby or toddler while
they are on the change table.
• Wherever your child is playing, always look to make
sure there are no objects within reach that are small
enough to swallow. As a guide, anything small enough
to fit inside a toilet roll is small enough for your baby to
swallow. You may need to look at the room from the
actual eye level of your child.
• Install smoke detectors throughout your home, check
them and change the batteries regularly. This will
protect not only your baby but the whole family. Contact
your local fire service for more information.
• Carefully supervise any interactions between your baby
and animals, especially dogs — particularly when dogs
are feeding, sleeping or with new puppies. Make sure
your baby is never left unsupervised near any family
pets when at home or out.
• As your child starts using their mouth to taste
everything around them, be aware of the dangers of
poisoning. Install a lockable cupboard, preferably up
high, in the kitchen, bathroom, laundry and garage to
store poisonous materials. Do not pour or decant
chemicals into another container (especially food or
drink bottles).
• Remove all alcohol from your baby’s reach (especially
after a party). It only takes a small amount of alcohol
to poison a baby.
7
Keeping your baby safe
Safety advice for you and your baby (continued)
• Be aware that hand sanitiser often used in the nappy
bag does contain alcohol and is not fitted with a child
resistant cap. Keep hand sanitiser out of reach of
children.
Out and about
• Avoid smoking near your baby. Keep cigarettes,
lighters, ashtrays and cigarette butts out of the reach of
children. Cigarettes and butts are poisonous to
children.
• Never leave your baby alone in the car — not even for
a minute.
• Check your home has a proper electrical safety switch
installed and operating to prevent electrocution.
• Every outside play area should be fenced off from
the street, pool/spa and driveway. On rural properties,
a special fenced area away from any dams or
waterways should be set aside as the children’s
play area.
• Every time your baby travels in a car they must be
rearward facing in an Australian Standard approved
baby capsule or child car restraint.
• Baby must be unwrapped before being placed in the
child car restraint, baby capsule, stroller or pram.
• Do not use a sling/pouch that places the baby on their back
in a curled ‘C’ position. Use an upright carrier that properly
supports the baby’s back, under the bottom and knees,
high on the parent’s chest with face and nose uncovered.
Do not use a carrier while cooking or preparing food.
• Always know where your baby is before reversing
your car.
• Always make sure your baby is strapped in securely
when they’re in a shopping trolley or stroller to prevent
falls. Always stay with them.
• As your child explores the backyard, be aware of
possible hazards including poisonous or irritating
plants, mushrooms, any unfenced water, sharp objects,
insects and animals.
8
• For more information call the Queensland Government
helpline on 1300 369 003, Kidsafe Queensland on
3854 1829 or contact your local ambulance station.
Effects of smoking on babies and children
Babies and children are at a higher risk of damage from
passive smoking than adults because of their smaller
developing bodies, higher breathing rates and less
developed respiratory and immune systems.
Children whose parents smoke are more likely to try
cigarettes and become regular smokers. Parents are role
models for their children, so setting an example by not
smoking can reduce the likelihood of your children taking
up smoking.
Babies of mothers who smoke or who are exposed to
second-hand smoke are at increased risk of SIDS.
Smoking is one of the most important modifiable risk
factors in reducing the risks of sudden infant death.
Smoking also increases the risks of babies developing
regular ear infections and associated hearing loss.
Quitting smoking is the best thing you can do for you and
your baby’s health. Quitline 13 QUIT (13 7848) provides
proactive support to pregnant mums and their partners
through the Quitline’s Smoke-free Mums and Bubs
program. This program involves a series of calls to get you
confidently on your way to a smoke free future.
You can reduce your baby’s exposure to cigarette
smoke by:
• keeping your car and home as smoke-free zones
Drinking alcohol after the birth of your baby
• designating outside smoking areas away from open
windows and doors, and using a smoking shirt over
your clothes
• smoking after feeding your baby, not before
• changing your own and your baby’s clothing often
during the day to remove contaminants
• not bed-sharing with your baby if you are a smoker
• not smoking while you are pregnant.
Alcohol can affect your coordination and reaction time
and can cause drowsiness. When you or your baby’s carer
has these effects, your baby may be at increased risk of
injury. The national alcohol guidelines recommend that
not drinking is the safest option when supervising or
caring for children.
Drug use after the birth of your baby
Side effects from taking drugs may mean you are not able
to respond to your baby’s needs as easily. If you or your
baby’s carer is less responsive as a result of these effects,
the baby may be at increased risk of injury. Some types of
drugs can have a sedative effect and others may make
you very tired even after the drug wears off.
9
Keeping your baby safe
Safe sleeping
To provide a safe sleeping environment for an infant:
• put your baby’s feet at the bottom of the cot
To help your baby sleep safely and reduce the risk
of sudden infant death:
• sleep baby on the back from birth, not on the tummy or
side
• make sure the cot meets the Australian standard for
cots
• sleep baby with head and face uncovered
• keep baby smoke free before birth and after
• ensure no additional mattresses or extra padding are
placed in a travel or porta cot
• provide a safe sleeping environment night and day
• tuck in bedclothes securely so bedding is not loose
• sleep baby in their own safe sleeping place in the same
room as an adult care-giver for the first 6 to 12 months
• keep quilts, doonas, duvets, pillows, cot bumpers,
sheepskins and soft toys out of the cot or sleeping
place.
• breastfeed baby if you can.
• use a firm, flat, clean mattress that fits snugly in the
cot
An infant sleeping bag that is the correct size for your
baby with a fitted neck, arm holes or sleeves and no hood
is a safe and effective way to keep your baby’s head and
face uncovered, as it makes extra bedding unnecessary.
Back to sleep
Tummy to play
Sit up to look at the world.
10
Bouncinettes, rockers, prams and strollers have NOT been
designed as sleeping products and therefore no baby
should be left unsupervised if they fall asleep in these
environments.
Sleeping with your baby
In many families, the mother or father shares the same
bed or sleep surface as their baby. In some circumstances,
sharing the same sleep surface may increase the risk of
sudden infant death.
SIDS and Kids recommends the safest place for a baby
to sleep is in their own safe sleeping place in the same
room as an adult care-giver for the first 6 to 12 months.
However, if you choose to share the same sleep surface
with your baby, the following guidelines may make it
safer.
• Sleep your baby on their back from birth – never on
their tummy or side.
• If your baby lies on his or her side to breastfeed, he or
she should be returned to the supine (back) position
for sleep.
• As an alternative to bedding, an infant sleeping bag
may be used so that your baby does not share the
adult bedding.
• Do not ‘wrap’ your baby if you are sharing a sleep
surface, as this restricts arm and leg movement.
• Make sure your baby cannot fall off the bed. A safer
alternative is to place the mattress on the floor (but be
aware of potential situations where your baby can
become trapped).
• Pushing the bed up against the wall can be hazardous.
Babies have died after being trapped between the bed
and the wall.
• Never place your baby to sleep in a bed with other
children or pets.
• Make sure the mattress is firm and flat.
• Never leave your baby alone on an adult bed, or put
your baby to sleep on a sofa, beanbag, waterbed or
soft, sagging mattress.
• Make sure that bedding cannot cover your baby’s face
or overheat your baby (use lightweight blankets and
remove pillows, doonas and other soft items from the
environment that could cover your baby).
• Three sided cots that attach to the side of the bed are
not safe or recommended. A four sided cot with the drop
side down, positioned beside the bed, provides a safe
sleeping environment close to a parent during sleep.
• Sleep your baby beside one parent only, rather than
between two parents, to reduce the likelihood of your
baby becoming covered by adult bedding.
• Sharing a bed with your baby while under the influence
of alcohol, a drug that causes sedation or alters your
level of consciousness, or when you are very tired,
increases your baby’s risk of Sudden Infant Death
Syndrome (SIDS) and fatal sleeping accidents.
• Ensure your partner knows your baby is in the bed.
11
Keeping your baby safe
Safe sleeping (continued)
Wrapping
For some babies, wrapping them in a lightweight cotton
or muslin wrap will help them to settle and sleep.
Wrapping is a safe and effective strategy to assist you
to settle your baby.
If you choose to wrap your baby, make sure:
• your baby is placed on their back while wrapped
• your baby’s face and head are not covered
• your baby is not overdressed under the wrap
• the wrap is firm, not tight
• Place your baby on their back to sleep.
• Change your baby’s head position every sleep.
• Have lots of tummy time when awake.
• Regularly change the position of toys that your baby
likes to look at.
• Encourage your baby to turn his or her head to either
side when you talk or play with him or her.
• you modify the wrap to meet developmental changes
e.g. arms are free once ‘startle’ or Moro reflex begins
to disappear (around 3 months of age)
• Put your baby to sleep at either end of the cot or
reposition the cot to face a different direction.
• your baby is not bed-sharing or sharing a sleep surface
with another person while wrapped.
• Avoid prolonged periods in car seats, strollers, swings
and bouncers.
When your baby can roll from their back to their tummy
and then back again when you are watching them (usually
4–6 months), you can stop using the wrap for settling and
sleep. Wrapping them may stop an older baby who has
turned onto their tummy during sleep from returning to
the back sleeping position.
• Do not change to a softer mattress.
For more information
12
Strategies to reduce the risk of positional
plagiocephaly (flattened area on the head)
developing
Contact SIDS and Kids on 1300 308 307 or visit the
website rednose.com.au
• Carry your baby in the upright position.
• Do not change your baby’s sleeping position to a side
or prone (tummy) position.
• Do not use a pillow or roll to keep your baby’s head
in position.
• Do not use ‘sleep positioners’ or ‘wedges’ to keep baby
on its back or side.
Keeping your baby safe
Immunisation
Immunisation is a simple and effective way of protecting
children from serious diseases including meningococcal
C, measles, mumps, German measles (rubella), polio,
Haemophilus Influenzae type B, whooping cough
(pertussis), hepatitis B, pneumococcal disease, rotavirus,
chickenpox (varicella), tetanus and diphtheria. These
diseases can cause hospitalisation, serious ongoing
health conditions (including cancer, brain damage and
deafness) and are sometimes fatal.
There is a strict timeframe for rotavirus vaccination and
no opportunity to catch up missed vaccination/s. Your
baby’s vaccinations commence at 6 to 8 weeks of age and
rotavirus will be given at the same time as other vaccines.
Refer to the schedule in you baby’s Personal Health
Record to keep track of when your baby’s immunisations
are due and make sure you take the PHR with you
whenever you take your baby for vaccinations so the
Official Vaccination Record can be filled in. You might
need this when enrolling your child in child care or school.
Vaccinate on time
It is really important for your child to be vaccinated on
time and according to the immunisation schedule.
Delaying or splitting vaccines on the schedule can
potentially expose your baby to dangerous vaccine
preventable diseases. Vaccines due at 2 months can be
given from 6 weeks of age.
Vaccines for parents and carers
While babies are still too young to have completed the
full set of immunisations, the best way to protect them
is by the parents and carers being immunised. This is
particularly important for whooping cough and influenza.
Whooping cough (or pertussis) is a highly contagious
disease spread by direct contact with infected nose or
mouth secretions e.g. coughing, sneezing, sharing food or
kissing. Complications of whooping cough in babies
include pneumonia, fits, and brain damage from
prolonged lack of oxygen. It can be fatal in young babies.
Whooping cough is most serious in babies who are less
than 6 months of age as they are not yet fully protected by
vaccination. Most hospitalisations and deaths from
whooping cough occur in babies less than 6 months of
age. Pertussis vaccination for people in close contact with
newborns is recommended and likely to reduce the risk of
whooping cough in infants
For more information
Visit www.qld.gov.au/health/conditions/immunisation.
Your doctor or immunisation provider will have the latest
immunisation schedule.
Download the free VacciDate app from your app store to
get reminders when each vaccination is due and to keep
records for every child in your family.
13
How your baby develops
Each baby develops at their own pace, usually through the
same stages or milestones and in about the same order.
Care for your baby
Babies grow and learn continually, but not always in
smooth and flowing patterns. Sometimes they practise
skills for quite a while and seem as if they will never move
on. At other times they learn many skills very quickly.
Helping your baby to develop a close relationship with
significant people in his or her life is a positive step
towards achieving this.
What is important is that your baby is happy, safe,
growing and making progress.
Keeping a record of your routines, including feeding and
sleeping routines, will assist if you ever have concerns
you would like to raise with your health professional.
Understand your baby
Understanding your child’s developing abilities and what
they can and cannot do at each stage will help you to:
• keep your child safe
• help your child develop
• understand your child’s behaviour
• gain satisfaction and enjoyment from the important
role of caring for your child.
14
Research shows that babies benefit from having active
play time every day. Aim to match play and movement
with your baby’s age and stage of development. Avoid
exposing your baby to the television and other screens.
Your baby needs to feel loved, secure and safe.
As well, try to avoid any family arguments or violence
around your baby. This will also help your baby to feel
safe.
More information
If you would like more information about your child’s
development or you are concerned about your child,
talk to your child health nurse or your doctor.
You could also ask at your local library for books on
child development or view a range of child health fact
sheets at the Raising Children Network site, www.
raisingchildren.net.au.
How your baby develops
0–3 months
Your baby’s movements
Feeding
Up to 3 months of age, most of your baby’s movements
are uncontrolled.
Breastmilk or infant formula is all the food your baby
needs until around 6 months. Your baby’s body is not
ready for solids before this time. Refer to the
breastfeeding and formula feeding sections in this
booklet for more information.
Babies have reflex movements, which they use for
survival. Some of these are sucking, sneezing and
swallowing. Some reflex movements — like throwing their
arms out, stiffening and crying when they hear a noise —
disappear after a short time.
At 1 month
At 1 month most babies:
• turn their head and eyes towards light
• watch faces while being fed or talked to
• may smile to show pleasure.
Between 1 and 3 months
Between 1 and 3 months most babies:
• become stronger
• lift their head and upper chest and may start
using their arms for support when on their tummy
Tummy time
Even though your baby should sleep on their back, it is
important for them to have some ‘tummy time’ from birth.
This can happen every day, when they are awake and you
are with them.
This will help your baby to develop essential movements
and skills like rolling, sitting, crawling and hand skills. It
also helps prevent plagiocephaly (see page 12).
At first, this can be following bath time when you are
drying your baby or during a massage time.
If your baby cries or becomes distressed:
• try tummy time for a shorter time but more often
• show an increasing awareness of people
• distract your baby’s attention by talking to your baby
and using toys
• smile and coo to show pleasure
• keep persisting!
• use joyful movements when expecting an enjoyable
event, like a bath or feed time
At a later stage — by 3 months — your baby should be
playing on his or her tummy when awake and you are
with them.
• settle to familiar sounds or voices, and are are startled
or jump when there is a sudden noise.
15
How your baby develops
0–3 months (continued)
Your baby and other people
Language
Babies develop skills for speech and language by
listening to the sounds around them. They also practise
making noises.
Talking, singing and reading to your baby will help them
to develop their speech and language. Make these a part
of every day. Bath times and nappy changes are good
times for this.
In the first few weeks, babies may respond to adults
talking to them by altering their breathing pattern and by
moving their mouth in response to seeing adults’ mouths
moving during speech.
Remember that when a dummy is in his or her mouth, it is
not possible for your baby to practise making sounds for
later speech development.
16
If your baby’s needs are responded to, they will learn that
they are loved and wanted, and they will build a sense of
trust and attachment. If you have difficulty comforting
your child, seek advice from your local child health nurse.
Playing and learning
Your baby learns from every activity you do with them —
talking to them, changing their nappies, bathing, feeding
or just being close in the same room.
For babies, play is for learning and practising skills, as well as
exploring and finding out about their world and the people in it.
During the first 3 months your baby will learn to:
• smile, chuckle and coo
• turn towards sounds
• look at and follow things with their eyes
• reach out and touch things with their hands.
Crying
Favourite play items
Crying is an important means of communication for young
babies. They always cry for a reason. These reasons include:
• tiredness
Favourite playthings for your baby at this stage include:
• attention from parents or caregivers
• hunger
• colourful mobiles, leaves or curtains blowing
in the breeze
• pain
• a variety of sounds to listen to
• discomfort, such as wet, hot or cold
• pram rattles or dangling objects to encourage
coordination of hands and eyes.
• parents’ anxieties (which babies quickly sense).
Safety
Make sure you are up to date with the safety
recommendations on pages 5–9.
Young babies are helpless and their early movements are
uncontrolled so they are totally dependent on parents and
carers for their safety. To help keep your baby safe,
remember the following.
• Babies should never be left in the care of older children,
no matter how reliable they seem.
• A
ll babies need to have their head supported until their
neck muscles are strong enough to hold up their head.
• Hold your baby when feeding them a bottle, rather than
propping them up. Babies can vomit or inhale milk.
Prop feeding can also increase the risk of ear infections
and associated hearing loss.
possible and a broadbrim/bucket or legionnaire style
hat. See page 86 for more sun protection tips.
• Every time your baby travels in a car, make sure you use
an approved baby capsule or child restraint. Not securing
your baby in a child car restraint or baby capsule will incur
a fine in excess of $350 and 3 demerit points.
• Never leave your baby alone in a car, not even for a
minute.
• Never leave your baby alone during bath time.
• Look inside mittens, bootees and socks to be sure
there are no loops or threads that can wind around your
baby’s fingers and toes and cut off blood circulation.
• Make sure there are no objects around your baby which
are small enough for them to swallow, including small
batteries and magnets.
• Do not heat your baby’s bottle in the microwave oven. The
milk can heat unevenly, risking scalding your baby’s mouth.
• Ensure that your baby is sleeping safely, according to
the guidelines on pages 10–12.
• Never leave your baby alone on a change table or other
furniture (especially a bed), in the bath, in the car or
near any family pets.
• Cigarette smoke is dangerous for your baby and no one
should be smoking near your baby. Babies and young
children are very susceptible to the health effects of
tobacco smoke because their lungs and immune
systems are still developing. Exposure to cigarette
smoke increases a child’s risk for developing ear
disease by 60 per cent. In Queensland you can be fined
more than $240 if you smoke in a car with a child under
the age of 16 years.
• Always make sure your baby is unwrapped and
strapped in securely when they’re in a pram, stroller or
shopping trolley. Always stay with them.
• Protect your baby from sun and heat. Seek shade when
outdoors and use SPF30 or higher water resistant
sunscreen, clothing that covers as much skin as
17
How your baby develops
3–6 months
Growth and development
• will turn head or eyes towards interresting sounds
Between the ages of 3 and 6 months, most babies:
• will make eye contact with you and you will smile
at each other
• appear to listen
• become more alert and are attracted by brightly
coloured or moving objects. They will look at curtains,
trees, shadows and mobiles
• can bring their hands together over their chest and look
at them. Your baby can now reach out for objects, grasp
them and hold them in their hands
• will dribble more as their mouths begin to produce
more saliva
• become aware of other parts of their body, such as
chest, knees, genitals and toes. Slowly they learn ‘what
is me’ and ‘what is not’
• learn to roll over from tummy to back and back to tummy.
Their view of the world changes when they learn to roll. It
is easier and safer for your baby to learn new movements
on the floor rather than on the bed or change table
• are developing skills for crawling. Tummy play will help
to develop strong neck and back muscles. This should
be encouraged during every wakeful period
• sleep less during the day, but probably a little more
at night
18
• are learning to sit with support
• wake easily to sound.
Language
Sounds are very interesting for babies at this age.
They are beginning to babble and make some speech
sounds themselves.
You will help your child’s language development by doing
the following:
• Talk and sing to your baby, even when you are doing
everyday things like changing a nappy, bathing or
feeding.
• Observe if your baby is responding and hearing sounds
as this is important when learning to talk.
• Smile and talk back to your baby whenever your baby
makes sounds or smiles.
• Read and tell stories to your baby every day.
• Remember that when a dummy is in your baby’s mouth
it is not possible for him or her to practise making the
sounds needed for later speech development.
• Repeat the sounds that your baby is making back to
them and add new sounds as well.
• Make sure your baby can see, touch and feel your face
while you are talking to them. This will help them to
copy your sounds and make new sounds.
Your baby and other people
Learning through play
Most babies are starting to develop their own personality
during these 3 months.
Practice makes perfect with babies.
They may be quiet, easygoing, impatient or demanding.
Parents can feel differently towards each of their children
and, since every child is unique, each child will react
differently to each parent.
Most babies at this age are friendly towards everybody.
Babies can be easily distracted during feeding, but they
usually manage to get enough food to stay healthy.
It is fascinating watching and helping babies learn about
themselves and their surroundings. If you give them the
opportunity, most babies will practise new activities until
they can do them.
From now on babies will explore things by holding, feeling
and looking at them in their hands and putting them in
their mouth. They will deliberately shake toys to make
noise.
Babies of this age like to gain attention by smiling and
‘talking’, and will usually smile in response to your or
another person’s face or smile.
Babies of this age:
• learn to sit with support
If your baby has been fed when hungry and comforted
when upset, they will begin to develop a sense of security
and trust.
• are mobile (rolling, wriggling or crawling).
Feeding
Breastmilk or infant formula is all the food your baby
needs until around 6 months. Your baby’s body is not
ready for solids before this time. Refer to the
breastfeeding and formula feeding sections in this
booklet for more information.
See page 68 for information on 'When and Why' to
introduce solid foods and other drinks .
• play with their toes
If you want to join your infant in their play it is often good
to follow their lead and play with what they want to play
with rather than directing their play.
You might like to consider joining a local playgroup.
Contact Playgroup Queensland for a playgroup near you.
www.playgroupqueensland.com.au.
19
How your baby develops
3–6 months (continued)
Toys
Make sure the toys you choose for your baby are safe,
durable and washable by checking the safe toy guidelines
on page 6. If toys are furry, remember babies can suck on
the fur and swallow it.
Lots of practice helps to develop new skills. At this age
babies need the following types of toys:
• bright, colourful objects within their sight
• rattles or toys that are stretched across the pram
(within reaching distance)
• rattles and other objects of various shapes, sizes and
textures for holding and exploring, such as small rattles
for small hands, toys with bells, soft blocks or balls
• safe household objects
• musical toys
• books
• toys on frames.
Safety
Make sure you are up to date with the safety
recommendations on pages 5–9.
20
Be aware that between 3 and 6 months, babies can move
independently, pick up objects and put them in their
mouths.
To keep your baby safe, remember the following
guidelines.
• Babies should never be left in the care of older children,
no matter how reliable they seem.
• Hold your baby when feeding them a bottle, rather than
propping them up. Babies can vomit or inhale milk.
Prop feeding can also increase the risk of ear infections
and associated hearing loss.
• Never leave your baby alone on a change table or other
furniture (especially a bed), in the bath, in the car or
near any family pets.
• Protect your baby from the sun and heat. Seek shade
when outdoors and use SPF30 or higher, water
resistant sunscreen, clothing that covers as much skin
as possible and a broadbrim/bucket or legionnaire
style hat. See page 86 for more sun protection tips.
• Every time your baby travels in a car, make sure you use
an approved baby capsule or child restraint. Never
leave your baby alone in a car, not even for a minute.
• Look inside mittens, bootees and socks to be sure
there are no loops or threads that can wind around your
baby’s fingers and toes and cut off blood circulation.
• Never leave your baby alone during bath time.
• Make sure there are no objects small enough to
swallow in the area where your baby is playing. Pins,
batteries, small magnets, dead insects, buttons,
beads, nuts, coins and other small objects may cause
your baby to choke. Cigarette butts are poisonous to
children.
As your child grows, they will become more mobile.
• Always make sure your baby is strapped in securely
when in a highchair, stroller or shopping trolley to
prevent falls.
• Food can be inhaled easily when starting solids at
around 6 months. Do not offer your baby small, hard
foods such as pieces of apple, carrot, popcorn or nuts
(see ‘Introducing solid foods’ from page 68).
• Check your home and garden for any poisons — or other
dangerous objects such as medicines — that could be
eaten. Put away all chemicals and cleaners in the
kitchen, laundry, bathroom and garage into a lockable
cupboard, high and out of reach. In the garden, remove
mushrooms and any poisonous or irritating plants.
Remember to discuss this with family and friends where
your baby visits.
• Ensure that your baby is sleeping safely, according to
the guidelines on pages 10–12.
• Cigarette smoke is dangerous for your baby and no one
should be smoking near your baby. Babies and young
children are very susceptible to the health effects of
tobacco smoke because their lungs and immune
systems are still developing. Exposure to cigarette
smoke increases a child’s risk for developing ear
disease by 60 per cent. In Queensland you can be fined
more than $240 if you smoke in a car with a child under
the age of 16 years.
• Provide short periods in a playpen to help your baby
accept safety limitations later.
If your baby has swallowed anything you think could be a
problem or if you suspect your baby has inserted (nose or
ear) or swallowed a button battery immediately contact
the Poisons Information Centre on 13 11 26.
21
How your baby develops
6–9 months
Growth and development
• understand simple words such as ‘no’ and ‘bye-bye’
From 6 to 9 months, babies are never idle. They need to
handle and explore things so they can learn more about
their surroundings.
• begin to copy speech sounds
Everything goes into their mouth, even their feet.
At this age they:
• grasp objects on sight
• focus on near and far objects and follow them
with their eyes across a room
• start trying to crawl.
By 9 months
Feeding
From around 6 months your baby is ready to start solid
foods with continued breastfeeding or formula feeding,
as explained in the breastfeeding and formula feeding
sections in this booklet. See P68 for information on
'When and Why' to introduce solid foods and other drinks.
Your baby and other people
Babies will:
• explore everything within reach
Over the months, babies learn a lot about the people
around them. Between 6 and 9 months they:
• recognise people they see every day
• search in the correct place for hidden objects
• are wary of strangers and less familiar people
• watch toys fall from the pram or highchair onto the floor
• e
njoy communicating with familiar people using eye
contact and facial expression.
• learn to roll easily from their tummy to their back and
then back to their tummy
• try to reach an interesting toy or object
• learn to sit without support
• start to move around on the floor (rolling, starting
to crawl, bottom shuffle, etc.)
• enjoy trying to eat with their fingers
22
• turn head to soft sounds.
• start drinking from a cup (spilling is common)
Babies may cry if their mother is out of sight even for a
short time because they cannot understand that she has
not left forever. Games like peek-a-boo help to teach
babies that people and things exist even when they are
not seen. This is a normal stage in your child’s
development as they are beginning to know the difference
between familiar and unfamiliar people.
Learning through play
Looking at books
Between 6 and 9 months babies develop further skills,
which they use when they play.
Babies can’t concentrate for long, but they love to look
at pictures and spend time with you talking about them.
Remember to choose a book that isn’t easily torn, has
bright and clear colours, and has only a couple of simple
objects on each page.
Making sounds
This includes shaking rattles, crumpling paper,
high-pitched squealing, laughing, joining sounds together
(ma-ma, da-da) and imitating noises they hear. You can
encourage this by repeating the sounds your baby makes
and adding new sounds as well. Remember that when
a dummy is in your baby’s mouth, it is not possible for
him or her to practise making the sounds needed for later
speech development.
Making conversation
This means listening to your baby and trying to
understand their messages, as well as you talking to your
baby. Talking to your baby and responding to their
attempts to communicate will encourage your baby to
develop language skills.
Handling and exploring
Handling and exploring toys and household objects helps
babies to learn about concepts like warm, cold, rough,
smooth, soft and hard. They learn by banging things
together, using their fingertips to grasp objects, passing
objects from hand to hand, picking up small things
between their fingers and thumbs, and mouthing objects.
Enjoying music
Singing and rocking in time to music, imitating actions to
songs and nursery rhymes, and clapping hands are all
ways babies enjoy music.
23
How your baby develops
6–9 months (continued)
Toys
Safety
Lots of practice helps to develop new skills. At this age,
useful toys include:
• bright, colourful objects, such as mobiles within your
baby’s sight
Make sure you are up to date with the safety
recommendations on pages 5–9.
• rattles or toys stretched across the pram
(within reaching distance)
• rattles and other objects of various shapes, sizes and
textures for holding and exploring, such as small rattles
for small hands, toys with bells, soft blocks or balls
• activity sets
• bath toys
• small blocks — larger than a match box, as anything
smaller could be a potential choking hazard
• safe household objects
• musical toys
• pull-along toys
• books
• balls.
Make sure the toys you choose for your baby are safe,
durable and washable by checking the safe toy guidelines
on page 6.
24
Babies from 6–9 months become very mobile as their need
to explore and learn about their world increases. Keep your
child safe by removing as many hazards as possible.
• Babies should never be left in the care of older children,
no matter how reliable they seem.
• Place your baby in a playpen for short periods each day
to help them to understand and accept safety
limitations later.
• Never leave your baby alone on a change table or other
furniture (especially a bed), in the bath, in the car or
near any family pets.
• Always make sure your baby is strapped in securely
when they’re in a highchair, stroller or shopping trolley
to prevent falls.
• Protect your baby from the sun and heat. Seek shade
when outdoors and use SPF30 or higher water resistant
sunscreen, clothing that covers as much skin as possible
and a broadbrim/bucket or legionnaire style hat. See
page 86 for more sun protection tips.
• Every time your baby travels in a car, make sure you use
an approved baby capsule or child restraint. Never
leave your baby alone in a car, not even for a minute.
• Keep baby in a rear-facing child car restraint as long as
possible – the road rule says 6 months but at least 12
months is recommended.
• Babies can transition to a forward facing child car restraint
when they have a strong neck – can sit on the floor
unaided without toppling due to the weight of their head
– and when they reach the minimum height marker of the
restraint.
• Look inside socks to be sure there are no loops or
threads that can wind around your baby’s fingers and
toes and cut off blood circulation.
• Never leave your baby alone during bath time.
• Make sure there are no objects small enough to
swallow in the area where your baby is playing. Pins,
batteries, small magnets, dead insects, buttons,
beads, nuts, coins and other small objects may cause
your baby to choke. Cigarette butts are poisonous to
children.
• Food can be inhaled easily when starting solids at
around 6 months. Do not offer your baby small, hard
foods such as pieces of apple, carrot, popcorn or nuts
(see ‘Introducing solid foods’ from page 68).
• Cigarette smoke is dangerous for your baby and no one
should be smoking near your baby. Babies and young
children are very susceptible to the health effects of
tobacco smoke because their lungs and immune
systems are still developing. Exposure to cigarette
smoke increases a child’s risk for developing ear
disease by 60 per cent. In Queensland you can be fined
more than $240 if you smoke in a car with a child under
the age of 16 years.
Your baby is very mobile and eager to explore. Check your
house thoroughly and often to keep your baby safe.
• All low cupboards should have child-resistant latches,
and drawers should have locks to limit access to
poisons, medicines, cleaning products, knives,
scissors and other dangerous objects.
• Be alert to your baby’s habit of wanting to taste
everything. Many things in the average backyard are
poisonous, including mushrooms, poisonous plants,
pool and garden chemicals. All poisons should be kept
locked in a cupboard in the kitchen, laundry, bathroom and
garage, out of your baby’s reach. Remember to discuss
this with family and friends where your baby visits.
• Inside the house, store medicines, cleaning aids and
any sharp or dangerous items well out of reach, or in
a cupboard with a child-resistant latch.
• Use safety barriers for steps, stairs and rooms you
don’t want your child to enter, and to keep them away
from fireplaces, swimming pools, heaters and spas.
25
How your baby develops
6–9 months (continued)
• Check your home and garden for drowning hazards.
Place nappy buckets high, out of the way, with the lid
securely fitted. Keep bathroom and toilet doors closed.
It only takes 5cm of water and 2 minutes for a child to
drown. Make sure the fence and gates for the swimming
pool work properly and are never propped open.
• Keep kettle and iron cords out of the reach of young
children. Use stove and bench guards and curly cords
to prevent children from pulling hot food and drinks
onto themselves. Always turn saucepan handles to the
back of the stove. Do not leave hot drinks or food
unattended or within reach.
• Cover power points when they’re not in use.
• Dangerous objects, like heaters and fans, should be
kept out of reach.
• Keep the bathroom door closed so your child can’t
touch the hot taps. Consult your plumber to reduce the
household water temperature to avoid scalds and
burns. Hot water regulators or thermostats should be
fitted on all bath hot water taps.
• Do not use baby walkers or or baby jumpers (jolly
jumpers). They are not recommended or necessary for
healthy development of babies.
26
• Dress your baby in nightwear made with fabric that
is slow to burn or designed to reduce fire danger.
Look for the low fire risk danger rating on the tag.
• Never leave your baby alone at other people’s homes
—especially where young children do not normally live
and where medication and other drugs may be stored
within reach, such as on bedside tables.
• Ensure that your baby is sleeping safely, according
to the guidelines on pages 10–12.
• On farms where there are waterholes, dams and creeks,
fence the house with a self-locking gate.
If your baby has swallowed anything you think could be a
problem or if you suspect your baby has inserted (nose or
ear) or swallowed a button battery immediately contact
the Poisons Information Centre on 13 11 26.
How your baby develops
9–12 months
Growth and development
From 9–12 months your baby will probably be able to:
• sit unsupported for quite a time
• turn sideways without losing balance
• stretch out to pick up a toy from the floor
• progress from rolling to wriggling to crawling on all
fours. Some babies have their own crawling style which
may not be usual, but their concern is getting
somewhere rather than how they do it
• pull themselves up to stand against furniture or
another support. At first when they pull up on a support
to stand up, they will not be able to lower themselves
slowly back to a sitting position. They may flop down or
cry for help, but will be back on their feet again in no
time
• gradually walk by stepping sideways, using furniture
for support
• learn to walk when their two hands are held, then with
one hand held
• possibly stand alone for a while, or even walk unaided
by 12 months.
Use of hands
Your baby’s ability to use his or her hands is developing
rapidly at this age.
Your baby is becoming more skilled and they can use
their fingertips for grasping and manipulating.
Because babies of this age can better control how they
release objects, your baby can now stack blocks and put
objects into containers.
They practise their throwing skills in a variety of ways,
e.g. toys and food are thrown from strollers and high
chairs.
Feeding
Your baby does not need all food to be made smooth at
this age. Introducing lumpy food before 9 months of age is
a critical window period to avoid the risk of later feeding
difficulties.
Your baby can now chew – even if they don't have teeth
yet. However, babies should not be given small, hard
foods such as pieces of apple, carrot, popcorn or nuts, as
they may choke on these.
Some babies will prefer to feed themselves with finger
foods but you will need to supervise. They will also enjoy
trying to hold a spoon to feed themselves.
Many babies of this age are interested in holding and
drinking from a cup, so help them to do this when a drink
is nearly finished, or use a lidded cup. Although this may
be messy, it will encourage your baby’s independence.
See P 72-74 for more information on feeding at this age.
27
How your baby develops
9–12 months (continued)
Language
Your child and other people
Babies between 9 and 12 months are interested in all
sounds, especially voices — their own and other people’s.
At this age, your child is more confident with other people
and enjoys the company of familiar adults, but:
• will sometimes object to new faces and voices
During this time they may say their first real word,
although it is often hard to hear it among the other noises
they make.
They love to:
• babble for amusement
• show what they want by pointing and making sounds.
The more you talk to your child and respond to their
attempts to communicate, the easier it will be for their
language skills to develop.
Babies learn language through lots of routine and
repetition. Babies will understand what you are saying
before they begin to use words. So at this stage, using
single words over and over will give your baby a chance to
hear words understand them and eventually copy them.
When talking to your baby about things they express
interest in, remember to get down to their level.
28
• may be distressed if you leave, even for a short while
• will enjoy communicating with familiar people using
eye contact and facial expression.
This is a normal stage of your child’s development as your
baby is still learning to know the difference between
familiar and unfamiliar people.
Learning through play
Playing is the way children learn about the world around
them. Lots of different types of play, suitable for the
child’s age, can give them the experiences needed to
develop and learn.
Your child needs opportunities to explore and experiment
with new skills. You can provide these experiences by
playing with and talking to your child.
Talking during everyday events, like changing a nappy
and bath time, helps to teach your child about language.
Games to play are:
• finger-toe songs and rhymes (e.g. ‘This little piggy’)
Reading books and talking about the pictures is another
enjoyable way to help your child’s language skills.
• clapping hands
• peek-a-boo
• listening to and copying sounds.
At this age, useful toys include the following:
• cars and trains for
pushing
• nesting cups
• activity sets
• household containers
• non-toxic crayons and
paper
• blocks and other
stacking toys
• peg puzzles
• soft cuddly toys
• bath toys
• medium to large balls.
You might like to consider joining a local playgroup.
Contact Playgroup Queensland for a playgroup near you.
www.playgroupqueensland.com.au.
Safety
Make sure you are up to date with the safety
recommendations on pages 5–9.
A safe place for your baby to explore and play is essential.
From 9–12 months, babies can move around very quickly
and quietly. They should not be left near windows,
balconies or on high pieces of furniture.
They don’t understand danger and can get into trouble
before you know it — so you need to be very watchful. Check
your house thoroughly and often to keep your baby safe. It
is useful to get down to your baby’s eye level and move
about the home to identify any hazards.
Remember: The more a baby can crawl, walk, climb and
explore, the greater the chance of injuries. This is also the
time when babies will use furniture to pull themselves up.
Take care with top-heavy furniture (including flat screen
televisions), which can topple over if not secured.
• Babies should never be left in the care of older children,
no matter how reliable they seem.
• Never leave your baby alone on a change table or other
furniture (especially a bed), in the bath, in the car or
near any family pets.
• Always make sure your baby is strapped in securely
when they’re in a highchair, stroller or shopping trolley
to prevent falls.
• Protect your baby from the sun and heat. Seek shade
when outdoors and use SPF30 or higher water resistant
sunscreen, clothing that covers as much skin as
possible and a broadbrim/bucket or legionnaire style
hat. See page 86 for more sun protection tips.
• Every time your baby travels in a car, make sure you
use an approved baby capsule or child restraint. Not
securing your baby in a child car restraint or baby
capsule will incur a fine of $341 and 3 demerit points.
• Keep baby in a rear-facing child car restraint as long as
possible – the road rule says 6 months but at least 12
months is recommended.
29
How your baby develops
9–12 months (continued)
• Babies can transition to a forward facing child car restraint
when they have a strong neck – can sit on the floor
unaided without toppling due to the weight of their head
– and when they reach the minimum height marker of the
restraint.
• Never leave your baby alone in a car, not even for a
minute.
• Never leave your baby alone during bath time.
• Make sure there are no objects small enough to
swallow around where your baby is playing. Pins,
batteries, small magnets, dead insects, buttons,
beads, nuts, coins and other small objects may cause
your baby to choke. Cigarette butts and even small
amounts of alcohol are poisonous to children.
• Place your baby in a playpen for short periods each day
to help them understand and accept safety limitations
later.
30
• Cigarette smoke is dangerous for your baby and no one
should be smoking near your baby. Babies and young
children are very susceptible to the health effects of
tobacco smoke because their lungs and immune
systems are still developing. Exposure to cigarette
smoke increases a child’s risk for developing ear
disease by 60 per cent. In Queensland you can be fined
more than $240 if you smoke in a car with a child under
the age of 16 years.
• Use safety barriers for steps, stairs and rooms you
don’t want your child to enter, and to keep them away
from fireplaces, heaters, hot ovens, swimming pools
and dams.
• Check your home and garden for drowning hazards.
Keep bathroom and toilet doors closed. Place nappy
buckets high, out of the way, with the lid securely fitted
— small children can fall into them head-first. It only
takes 5cm of water and 2 minutes for a child to drown.
Make sure the fence and gates for the swimming pool
work properly and are never propped open.
• Keep kettle and iron cords out of the reach of young
children. Use stove and bench guards and curly cords
to prevent children from pulling hot food and beverages
onto themselves. Make sure saucepan handles are
turned to the back of the stove. Do not leave hot drinks
or food unattended or within reach.
• Cover power points when they’re not in use.
• Circuit breakers save lives and can be installed by
an electrician.
• Make sure all low cupboards have child-resistant
latches.
• Check that your furniture — like coffee tables — is
sturdy enough for your child to pull himself or herself
up to stand.
• Strap your TV to the wall or to a stable TV cabinet.
• Ensure free-standing bookshelves, cupboards and
chests of drawers are secured to the walls.
• Do not place pretty objects or toys on the top of
furniture that will encourage the baby to climb for them.
• Store medicines, cleaning aids, detergents and any
sharp or dangerous items well out of reach, or in a
cupboard with a child-resistant latch.
• Dangerous objects, like heaters and fans, should be
kept out of reach.
• Keep the bathroom door closed so your child can’t
touch the hot taps. Reduce the household water
temperature to avoid scalds and burns. Hot water
regulators or thermostats should be fitted on all bath
hot water taps.
• Ensure there are safe play areas outside. Regularly
check for objects, plants, insects and animals that
could harm your child, e.g.
-- garden tools
-- protruding branches
-- garden fertilisers or chemicals
-- pool chemicals
-- poisonous plants and mushrooms (especially after
rain).
• Ensure play areas are shady and fenced from the pool,
roads and reversing cars’ driveways.
• Do not use baby walkers or or baby jumpers (jolly
jumpers). They are not recommended or necessary for
normal healthy babies.
• Dress children in nightwear made with fabric that is
slow to burn or designed to reduce fire danger. Look for
the low fire risk danger ratings on the tag.
• Avoid giving your baby any small, hard food to eat, like
pieces of apple, carrot, popcorn or nuts, as they may
choke on these.
• Ensure that your baby is sleeping safely, according to
the guidelines on pages 10–12.
If your baby has swallowed anything you think could be a
problem or if you suspect your baby has inserted (nose or
ear) or swallowed a button battery immediately contact
the Poisons Information Centre on 13 11 26.
31
Taking care of your baby’s teeth
About baby teeth
Low fluoride toothpastes created especially for children
under 6 years of age are available in most supermarkets
and pharmacies.
Healthy teeth allow children to:
• eat a nutritious diet
• speak properly
• have a healthy smile.
Baby teeth also help to maintain the space for the adult
teeth. Early loss of a baby tooth can reduce the space
for an adult tooth, resulting in crowding.
The timing of the
appearance of baby
teeth can vary greatly.
This diagram is a general
guide to when baby
teeth should appear.
9 months
10 months
Parents should assist with brushing of teeth until children
are about 8 years of age.
Fluoride
18 months
Fluoride protects teeth.
15 months
Fluoride can be obtained through fluoride toothpaste and
fluoridated water.
27 months
Taking care of teeth
As soon as your baby’s teeth appear, brush them with
a child-sized, soft toothbrush. Clean their teeth daily
because plaque (a sticky, invisible film of bacteria
and left-over food) will form in your baby’s mouth just
as it does in your own.
32
Children only require a small amount of fluoride
toothpaste and should not be allowed to dispense
toothpaste without supervision. Toothpaste should be
kept out of reach of children.
Brush your baby’s teeth with a small, pea-sized amount
of low fluoride toothpaste after your baby turns 6 months
in non-fluoridated areas and after 18 months in
fluoridated areas*.
Fluoride supplements do not provide the same benefit
as fluoridated water. If your water supply is not fluoridated,
seek advice on your options from your dentist.
Teething problems
Some babies and toddlers may experience teething
problems such as:
• red, swollen gums
• irritability and restlessness
• flushed cheeks or fever • dribbling
• finger and fist-sucking.
* Your dentist will be able to advise if your local water supply is fluoridated. For more information on oral health,go to www.health.qld.gov.au/oralhealth
Mild teething problems may be eased by letting your
baby chew on objects such as crusts of bread, rusks
or teething rings.
Rubbing your child’s gums with your finger or applying
a small amount of teething gel may also help to ease
teething pain.
Your oral hygiene could affect the oral health
of your baby
Newborn babies do not have the bacteria (germs) in their
mouth that can cause tooth decay (holes). Anyone,
including the mother, can pass the bacteria that causes
tooth decay on to a baby through sharing spoons or
cleaning a dummy or bottle in their own mouth.
It is important for parents to have good oral hygiene –
brushing twice a day with a small, soft toothbrush and
fluoride toothpaste – to reduce or eliminate the chance
of transmitting bacteria to their baby.
What is infant tooth decay?
Infant tooth decay occurs soon after the first teeth
appear. Infant tooth decay occurs more often when
children are given bottles containing sugary drinks, such
as juice, cordial and soft drink.
Infant tooth decay is less common in breastfed babies.
How to prevent infant tooth decay
• Breastfeeding is best for your baby.
• If your baby drinks from a bottle, only put breastmilk,
formula or water in your baby’s bottle. Hold your baby
close when feeding. Do not leave your baby alone to
drink the bottle.
• As soon as your baby’s teeth appear, brush them with
a child-sized, soft toothbrush. Introduce a small,
pea-sized amount of low fluoride toothpaste after your
baby turns 6 months in non-fluoridated areas and after
18 months in fluoridated areas*.
• Ensure all family members have good oral health —
brushing twice a day with a small, soft toothbrush and
fluoride toothpaste — to prevent the transmission of
bacteria to your baby.
• If using a dummy, do not sweeten or flavour it. Never
clean a dummy in your mouth as this will transfer
bacteria from your mouth to your baby. Check the
dummy regularly for rips and tears and replace it if these
are found.
• Try introducing a cup from about 6 months of age and
try to stop bottle use from about 12 months of age.
• Remember, infant tooth decay is preventable. If you
think your baby has infant tooth decay, or you would
like additional information about preventing it, contact
your dentist.
33
Taking care of your baby’s ears
Why is ear and hearing health important?
Healthy hearing is critical to your baby’s speech and
language development from the earliest months of life.
Between one and two babies out of every 1000 will have a
significant hearing loss. To identify babies who may be
born with a hearing loss, all babies are offered a newborn
hearing screen. Ideally, this screen is done before your
baby leaves hospital after birth.
The newborn hearing screen gives a ‘pass’ or ‘refer’ result
for one or both ears. A ‘pass’ result in both ears means
your baby is unlikely to have a hearing loss that affects
speech and language development. If your baby receives
a ‘refer’ result in one or both ears, they will be referred to
an audiologist for further testing to confirm if your baby
has hearing loss and whether the hearing loss is
temporary or permanent. Ongoing support and treatment
options are provided to all babies with temporary or
permanent loss based on the diagnosis they have
received. If your baby has a permanent hearing loss you
will be referred to the Queensland Hearing Loss Family
Support Service for support and assistance.
There are also some babies who pass the newborn
hearing screen but have known risk factors for acquiring
some types of hearing loss that take longer to appear. If
this is the case, your baby will be referred for further
34
testing by an audiologist before their 1st birthday. If you
are unsure of the result of your baby’s newborn hearing
screen or if they have a hearing loss risk factor, refer to the
results recorded on the Healthy Hearing page in your
baby’s Personal Health Record book.
If your baby passes their newborn hearing screen, hearing
problems can still arise. A hearing pass at birth is not a
pass for life and parents are encouraged to continue to
monitor their child’s hearing over the first 12 months.
Hearing problems often arise from middle ear infections
which is a common childhood illness. When a child has a
middle ear infection it can affect their hearing and they may
not turn to your voice or respond to loud noises. One ear
infection in the first 12 months is not unusual but more than
three infections can lead to serious health concerns. Some
babies get frequent, severe and persistent middle ear
infections which can lead to chronic ear disease and hearing
loss. This will impact how they learn to talk, learn and play.
Chronic ear disease and associated hearing loss is a
particular concern for Aboriginal and Torres Strait Islander
babies and children. If your baby is Aboriginal and/or Torres
Strait Islander it is recommended that you have your baby’s
ears checked whenever they attend a health clinic. The health
clinic can provide you with information on how to prevent,
identify and manage ear infections.
How to prevent and detect ear and hearing
problems
Signs and symptoms of middle ear disease in babies
include:
Middle ear infections are common but there are a number
of things parents can do to look after their baby’s ear and
hearing health, including:
• breastfeeding their baby
• not smoking near their baby
• ensuring their baby receives all their scheduled
immunisations
• ensuring people who play with the baby wash their
hands and faces before cuddling and kissing the baby
• using tissues when wiping their baby’s nose and
putting them in the bin and washing their own hands
• getting baby’s ears checked regularly by a child health
nurse, hearing health worker or doctor.
Early detection gives babies and children the best chance
for strong hearing to talk, learn and play. If your baby
shows any of the following signs and symptoms of having
a middle ear disease or is struggling to meet the healthy
hearing checklist, it is recommended you take your child
to see a health professional for an ear and hearing check.
Formal hearing checks can be performed on babies at any
age. For some babies, there will be no observable signs
and symptoms of middle ear disease, so ask your health
professional to check your baby’s ears every time your
baby has a health check or visits the doctor.
• signs of a cold (coughing, sore throat and runny nose)
• pain in the ear
• runny fluid or pus from the ear
• babies pulling at ears
• can’t hear properly
• not eating
• diarrhoea or vomiting
• young babies being unsettled and hard to put down.
Healthy hearing checklist for babies:
Birth to 3 months • Settles to familiar sounds or voices
• Is startled or jumps when there is a
sudden noise
3 to 6 months • Turns head or eyes toward
interesting sounds
• Appears to listen
• Wakes easily to sound
• Starts to make speech-like sounds
6 to 12 months • Understands simple words such as
‘no’ and ‘bye-bye’
• Begins to copy speech sounds
• Turns head to soft sounds
35
When your child is sick
It is very concerning for parents when their young children
are sick. It is especially important to be able to tell the
difference between a serious illness and a minor one.
Parents also need to learn how to pick up the signs of
illness early so that treatment and care can begin as soon
as possible. This is especially important for very young
babies and children, as their condition can deteriorate
more quickly than older children.
Signs of sickness
Most — but not all — illnesses in young children will be
accompanied by a fever (temperature above 37°C), but
not all children with a fever will be sick.
You will need to look at your child and ask yourself:
• is my baby not feeding?
• is my child unhappy?
• is my child lying around, not interested in playing or
their surroundings?
Other signs to watch out for if your child is unwell
36
It is important, especially with babies and young children,
to watch out for other important signs if they are unwell.
• Drowsiness and loss of interest in playing and
interacting with you — the baby or young child may be
less alert than usual and not interested in what is going
on around them. The child may prefer to just be cuddled
and may be ‘floppy’.
• Breathing difficulty — breathing may be noisy, rapid,
and/or shallow, or the child may take long pauses
between breaths. The baby may make a grunting
sound, or the ribs or breastbone may be sucked in with
each breath.
• Poor feeding or loss of appetite — the baby or child may
suck less vigorously, for shorter periods or refuse feeds
altogether. This needs to be taken seriously in an
infant. Taking less than half the normal amount of feed
in a 24-hour period is of concern.
• Poor urine output — less than four wet nappies in a
24-hour period is a concern. This may be difficult to
assess if the child has diarrhoea. For an older child,
their urine will be reduced in amount and it may be
concentrated (a brown to orange colour).
• Change in skin colour — the baby or child may be very
pale, have mottled skin, a rash or cold hands and feet.
• Change in poo — very loose poos, absent poos, signs of
blood in poos or change in colour of poos may occur.
• Redness around the ears or discharge from the ears —
the baby may be pulling at their ears because they are
experiencing pain or there is a visible discharge (runny
fluid or pus) coming from the ear.
When to see the doctor
Fevers
Seek medical attention — such as your local hospital
or medical centre — as soon as you can if:
• you observe any of the signs of sickness mentioned
previously, especially if a number of these occur
together
• you have a very young baby whom you suspect is
unwell
• you are concerned about your child.
A fever is where there is a rise in the body’s temperature.
It is also important to seek help if your child:
• develops a rash
• has a convulsion or fit
• has a fever greater than 39°C (38°C if baby 3 months)
• vomits persistently for hours or vomits green fluid
or blood
• has pain that is not relieved by paracetamol or
ibuprofen
• develops a lump or swelling — especially in the groin
• stops breathing for more than 15 seconds
• has a severe headache, neck stiffness or light hurts
their eyes.
• Remove excess blankets and clothing and keep the
child lightly dressed.
Fevers are the body’s natural response to fighting
infection. The infection responsible for producing the
fever can be a virus or bacteria. It is sometimes difficult to
distinguish which is the cause.
There are some important guidelines you should follow
if your child has a fever.
• Keep your child at rest and comfortable.
• Do not allow them to shiver as this contributes to a rise
in temperature. If they do shiver, wrap them in a light
blanket until the shivering stops.
• If your child is under 6 months of age, give them extra
breastfeeds, bottles or cooled boiled water. For older
children give frequent small drinks of clear fluid
(including water or diluted fruit juice — one part juice to
four parts water). A child with a fever will be thirsty
and, if they’re not vomiting, can drink as much fluid as
they desire.
• Regularly check your child’s temperature with a
thermometer — mercury and digital thermometers are
the most accurate. Plastic tape thermometers used on
* If you are having difficulty connecting it may be useful to dial 13 HEALTH using only the forehead are not reliable.
Further advice can be obtained by calling
13 HEALTH (13 43 25 84*).
the first six digits of the phone number (13 43 25). If you are still unable to connect
to 13 HEALTH then please contact your service provider to discuss the issue.
37
When your child is sick
Medication
Paracetamol
If your child generally seems well and happy, there is
no need to treat a fever with medication.
Follow directions on the bottle according to you child’s
age and weight.
However, paracetamol or ibuprofen can be given in the
correct dose to treat a fever above 38.5°C if the child is
irritable or in pain.
Dose can be given every 4-6 hours. Do not exceed 4
doses within 24 hours.
Read the bottle carefully before giving your child a dose,
and talk to your pharmacist if you have any concerns.
Record doses given to keep track of medication use. This
is particularly important if there are two or more carers
(e.g. Mum and Dad) to make sure your child doesn’t
accidently get an overdose.
Do not use paracetamol or ibuprofen for more than
48 hours without talking to a doctor.
Do not give aspirin to children without first seeking
medical advice.
Dosage
Multiple brands and strengths of medications are available
so always follow the guidance on the packaging for age and
weight for that particular medicine. If two different doses
are recommended (one for weight, one for age) always give
the lowest dose recommended. Do not combine
medications unless advised by a health professional.
38
If you think you may have given too much medication call
the Poisons Information Centre on 13 11 26.
Ibuprofen (for example Nurofen®)
Follow directions on the bottle according to your child’s
age and weight.
Ibuprofen should only be used in children over 3 months
of age unless recommended by your paediatrician.
Precautions are required so contact your doctor or
pharmacist first before administering to your child.
Dose can be given up to every 6-8 hours. Do not exceed
more than 3 doses in 24 hours. Give with food or after
breastfeeding to reduce the risk of stomach upset.
Remember
All children need extra care and attention when they
are sick. Keeping them at rest and at home can be
important to recovery and will minimise the risk of
transferring infection to other children.
Young children have no idea why they feel the way they
do when they are sick and will be irritable and upset.
Your presence and reassurance are vital to their recovery.
Breastfeeding
Best for baby and for Mum
Nature has provided mothers with the perfect food for
babies — breastmilk. You can give your baby something
that no one else can, and it’s natural, free and
environmentally friendly. Breastfeeding gives your baby
the best possible start in life. Support from family and
friends is a really important part of establishing and
continuing breastfeeding.
Added advantages for your baby
Breastfeeding is more than providing food for your baby.
Holding your baby close during breastfeeding builds
a close, loving bond between you. Your baby can feel,
smell and see you. Breastfeeding helps build a special
relationship with your baby.
• gastrointestinal infections (e.g. diarrhoea)
Your breastmilk not only has all the nourishment that
your baby needs, but it also reduces the risk of your baby
developing infections and diseases such as:
• otitis media (e.g. ear infection), which can lead to
hearing loss
• urinary tract infections
• atopic diseases (e.g. eczema, asthma)
• inflammatory bowel disease
• some childhood cancers
Breastfeeding provides the perfect natural mix of
nutrients that your baby needs in a form especially
designed for your baby’s maturing digestive system and
growing body. Breastmilk is made especially for your
baby.
• sudden infant death syndrome (SIDS)
Like anything new, breastfeeding may take a little time to
get established. You may experience some difficulty in
the early stages, but the advantages to both you and your
baby are worth it.
Breastfeeding also reduces the risk of your baby
developing allergies and food intolerances, such
as coeliac disease.
• type 1 and type 2 diabetes
• obesity in childhood and in later life
• heart disease in later life.
Breastfeeding promotes jaw development.
All the goodness in breastmilk is yet to be discovered,
so it can’t be replicated in infant formula. Breastfed
babies are less likely to get infections and are less likely
to go to hospital than formula-fed babies.
39
Breastfeeding
Best for baby and for Mum (continued)
Added advantages for you
• Breastfeeding helps your uterus return to its
pre-pregnant state faster.
• Breastfeeding can help you lose weight after your
baby’s birth.
• Breastfeeding lessens the likelihood of ovarian cancer
and pre-menopausal breast cancer.
• Breastfeeding lessens the likelihood of osteoporosis.
• Breastfeeding lessens the likelihood of mothers with
gestational diabetes developing type 2 diabetes.
Convenient, safe and natural
• Breastmilk is always available and is fresh, clean
and safe.
• It is the only food that your baby needs for around
the first 6 months.
• It is good for your baby even when he or she is more
than 12 months old.
• It saves you time as you don’t need to prepare formula
and sterilise bottles.
• It is always ready for your baby.
40
Breastfeeding
Getting started
Here are some commonly asked questions and answers
about breastfeeding.
When do I start breastfeeding?
Most babies are alert and have a strong desire to feed
after birth, so start as soon as possible. Hold baby close
to you and most babies will start searching to feed within
an hour or so of birth. Your body will have already
produced colostrum (baby’s first milk), which is perfect
for your newborn baby.
How does my body produce milk?
During pregnancy, your body begins to produce
colostrum: a thick, rich, yellowish fluid. As you
breastfeed, the colostrum changes into mature
breastmilk. Breastmilk is never too rich or too weak. It
may look pale whitish blue as it changes to suit your
baby’s needs, but it has all the nourishment necessary.
When your baby starts sucking, you may feel a tingling or
tightening sensation in your breasts. This feeling, known
as ‘let-down’ or ‘milk-ejection’, occurs at other times too
(e.g. when you hear your baby cry). Not all mothers feel
their ‘let-down’ but watching the change in your baby's
sucking-swallowing pattern will show you it is happening.
Breastmilk production works on supply and demand.
The more you breastfeed your baby, the more breastmilk
you will produce.
What do I need to help me to breastfeed?
While your body has prepared itself for breastfeeding
during pregnancy, there are a number of things you can
do which will help, especially in the early months.
• Obtain breastfeeding information e.g. visit
www.qld.gov.au/health/children/babies/
breastfeeding/ or www.health.qld.gov.au/
breastfeeding or ask your midwife or doctor.
• Join a breastfeeding support group and talk to other
breastfeeding mothers.
• Find out what breastfeeding support is in your area
before you leave hospital, e.g. child health clinic,
lactation consultant, the Australian Breastfeeding
Association and post-discharge services that support
breastfeeding.
• Try to sleep or rest when your baby is asleep.
• Accept offers of help with housework and meals from
your partner, family and friends. Let them know about
the benefits of breastfeeding so they can better
support you.
• Do only essential housework.
• Enjoy a wide variety of nutritious foods (see "What
should I eat?" on the next page). Avoiding certain foods
will not prevent allergy development in children, nor
affect the baby's "wind". Try to keep physically active and
eat according to your energy needs.
41
Breastfeeding
Getting started (continued)
• Drink plenty of fluids. A good habit is to have a drink
of water every time your baby feeds.
• Avoid cigarettes, alcohol and other drugs, coffee
and cola. If you find this difficult, talk to your health
professional for support and advice about how to
minimise the effects these products can have on your
baby. These products contain ingredients that pass on
to your baby through your breastmilk. If you decide to
continue to have these products, have them after a
breastfeed rather than before.
• If you need to take medication, ask your doctor to
prescribe medication that is safe while breastfeeding.
Pregnancy and breastfeeding are some of the most
nutritionally demanding times for your body, so it’s really
important to eat healthy foods to make sure both you and
your baby are as healthy as possible. This will make it
easier to cope with looking after your baby. Eat a variety
of foods from each of these groups every day:
• grain (cereal) foods, mostly wholegrain and/or high
cereal fibre varieties
• vegetables and legumes/beans
• fruit
• Get everything ready — e.g. drinks and pillows — before
you start the feed or at the end of the last feed.
• lean meats and poultry, fish eggs, tofu, nuts and seeds
and legumes/beans
• Your baby may need to feed very frequently in the first
weeks of life. As they grow, they will go for longer
between feeds (but feeding frequency may increase
during different developmental stages, and sometimes
towards the end of the day). Be assured that
breastfeeding during the night is both necessary and
normal for babies.
• milk, yoghurt, cheese and/or alternatives, mostly
reduced fat.
• Get to know your baby by cuddling and observing their
cues. Be guided by your baby’s feeding cues, not the
clock or others feeding schedules.
42
What should I eat?
• If you plan to return to work, talk to your employer
about working and breastfeeding.
An iodine supplement of 150 micrograms each day is
recommended in pregnancy and during breastfeeding.
Iodine supports normal development of the brain and
nervous system before birth, in babies and young
children. If you have a pre-existing thyroid condition
check with your Medical Practitioner first.
If you are following a special diet or a vegetarian diet, you
may need extra advice from a dietitian/nutritionist.
Breastfeeding mothers need to drink plenty of fluids,
especially in warm weather. Water is the best drink.
How do I help get milk flow started?
At home
There are some things you can do to help your breastmilk
let down.
• Do what you can to relax — breathe deeply, lower your
shoulders, get someone to give you a back rub and try
to enjoy this special time with your baby.
Talk to your local child health nurse, a lactation
consultant, an Australian Breastfeeding Association
counsellor or your general practitioner.
• Have a warm shower or put a clean warm washer on
your breast.
• Gently massage your breast towards the nipple.
• Express a small amount of breastmilk just before a
feed.
Breastfeeding is a learned skill that doesn’t always come
easily. Many women experience some difficulties,
particularly in the early days. If you have any concerns,
are experiencing any difficulties or need reassurance,
contact a health professional. Addressing issues early will
make breastfeeding a more enjoyable experience for you
and help you to keep breastfeeding for longer.
For more information or assistance
Telephone
• Your local child health nurse (see Queensland Health
Community Child Health Service in the White Pages).
• 13 HEALTH (including 24-hour child health information
and advice) 13 43 25 84.*
• Australian Breastfeeding Association 24-hour/7-day
free Breastfeeding helpline. Call from anywhere in the
state on 1800 686 268.
• The Queensland branch of the Australian Breastfeeding
Association can be contacted by calling (07) 3324 0577
or emailing abaqld@powerup.com.au.
Websites
• Queensland Health Breastfeeding
www.health.qld.gov.au/breastfeeding
In hospital
• Australian Breastfeeding Association
www.breastfeeding.asn.au
Talk to a midwife or lactation consultant about any
concerns you have.
• Lactation Consultants of Australia and New Zealand
www.lcanz.org
* If you are having difficulty connecting it may be useful to dial 13 HEALTH
using only the first six digits of the phone number (13 43 25). If you are still
unable to connect to 13 HEALTH then please contact your service provider
to discuss the issue.
43
Breastfeeding
How do I start a breastfeed?
• Relax and make yourself comfortable.
• Allow for skin to skin contact prior to a breastfeed.
• Hold your baby close with their chest against yours.
• Hold the baby behind the shoulders and back, allowing
the baby’s head to tilt backwards, ensuring a wide
mouth and deeper latch.
• When attaching your baby, always bring your baby
towards the breast — not breast to your baby.
• Your baby’s top lip should be level with your nipple.
You can encourage your baby to open his or her mouth
wide by teasing the baby’s mouth with your nipple.
Squeezing a little milk from the breast will encourage
this even more. When your baby opens wide, bring
him or her quickly to the breast. The baby's chin should
be tucked well into the breast, and the mouth should
be wide open with the bottom lip curled back.
Correct breast attachment and positioning of your baby
are vital to avoid problems.
• If the cheeks are being sucked in or you can hear
a ‘clicking’, your baby is not attached properly.
• If it hurts when your baby sucks or you suspect poor
attachment, put your finger in his or her mouth to break
the suction and try reattaching again. Just pulling your
baby off before suction is broken will hurt.
• Breastfeeding should not be painful. Some women
experience nipple sensitivity and tenderness in the
first few days.
• Listen and observe your baby during a feed. Your baby
should look comfortable, relaxed and not tense or
frowning.
• Make sure your nipple and a large amount of the areola
(the darker area around the nipple) are inside your
baby’s mouth.
• After feeding, your nipples will appear slightly longer
but should not look squashed, flattened, white or
ridged.
• Remember to cradle your arm around your baby once
he or she is comfortably attached.
Remember, attachment gets easier wih time.
• After an initial short burst of sucking, the rhythm will be
slow and even. Pauses are a normal part of the feed
and will become more frequent as the feed continues.
44
How will I know my baby is correctly attached
to my breast?
• Make sure baby's nose is not obstructed by the breast.
Good and poor attachment
Good attachment
inside appearance
Remember
Poor attachment
inside appearance
Painful feeding is a sign that something may be wrong.
Your Community Child Health nurse, Australian
Breastfeeding Association, lactation consultant or
midwife can help you.
About nipple shields
Nipple shields are a short term intervention for cracked,
painful, inverted or flat nipples. If you are using a nipple
shield on discharge from hospital, seek assistance from
a breastfeeding trained professional within a few days
of leaving hospital to support supply and breastfeeding
attachment.
Good attachment
outside appearance
Poor attachment
outside appearance
Source: World Health Organisation, Breastfeeding Counselling: A Training
Course, 1993, UNICEF, New York. Reproduced by permission.
45
Breastfeeding
How do I start breastfeeding? (continued)
How often should I breastfeed my baby?
• Babies need to feed often. They can have around
8–12 feeds in 24 hours. Mothers and babies vary a lot.
How often you feed and how long it takes your baby to
feed differs from one mother to the next. With patience,
you and your baby will develop your own pattern which
will adapt as your baby grows. Demand feeding allows
your baby to let you know what he or she needs.
• It is fine to give your baby an extra feed to settle them.
• Let your baby feed as long as he or she wants to.
Some babies will have a rest at the breast and then
start sucking again, so let your baby decide when to
come off. As a guide, try to keep your baby’s feeds no
longer than one hour.
• Your baby will know when they are hungry so you can
feed to suit your baby’s needs.
Tip
• Feeding times vary from feed to feed and baby to baby.
As babies get older and are able to suck more
efficiently, they often have shorter feeds and may sleep
longer between feeds.
If your baby feeds for longer than one hour on a regular
basis, it may indicate a feeding problem (e.g. incorrect
attachment). Access your local Community Child Health
Service or the Australian Breastfeeding Association for
ongoing support.
• It is normal for babies to breastfeed frequently, during
the day and night.
• Breastmilk is the perfect food for babies.
• Breastmilk is easily digested and this can mean it
empties from your baby’s stomach in 90 minutes, so
some babies need to feed quite often.
• When the weather is warm, they may want to
breastfeed more than usual. You don’t need to give
them water as well as breast milk.
46
• Let your baby finish the first breast before offering
the second breast. At the next feed, reverse the order.
Breastfeeding
Is my baby getting enough milk?
How do I know my baby is getting enough milk?
• B
reastfed babies usually demand feed 8–12 times in a
24-hour period.
• Watch for frequent swallowing. Swallowing after 1–3
sucks is normal.
• After your milk comes in (4–6 days) baby should have
at least 6–8 wet cloth nappies or 5–7 wet disposable
nappies in 24 hours. Their wee should be pale in colour.
• Breastfed babies are rarely constipated, so a dirty
nappy can occur after each feed. Typical breastfed
babies’ bowel motions are loose and mustard yellow
but can sometimes be green or orange. If concerned,
review with a trained health professional. None of
these changes are a problem in a healthy breastfed
baby. They will be different to the bowel motions of
formula fed babies.
• The number of bowel motions of breastfed infants
tends to decrease between 6 weeks and 3 months of
age. Intervals of several days or more between stools
are common.
• Frequent, runny stools do not mean a breastfed infant
has diarrhoea or lactose intolerance – they should
simply be viewed as evidence of sufficient milk. If
concerned, review with a trained health professional.
• Your baby should have bright eyes, a moist mouth and
good colour.
• Your baby should be mostly contented after feeding.
Most babies will have an unsettled period somewhere
in the day. This should not be misinterpreted as running
out of milk at the end of the day.
• Your baby’s weight gain should be going well. Babies
lose weight shortly after they are born. They start to
regain this weight by day 4–6 and should have
regained their birth weight by 2 weeks. After this, check
your baby’s growth regularly and make sure it is
recorded on the growth chart in your baby’s Personal
Health Record book. The fact that your baby’s growth
follows the general pattern or curve of the graph is the
most important thing. A baby who is gaining weight is
getting enough breastmilk. A judgement on your baby’s
growth is best made only after a series of
measurements. A one-off unusual measurement is not
usually cause for concern if your baby is contented and
healthy. Check the accuracy of measurements, use the
same baby scales all the time and always weigh
without clothes and nappy (or always with a dry nappy).
• Growth monitoring is best done by a health
professional who can discuss your child’s development
with you. It is important to consider growth using both
weight and length measurements in combination.
47
Breastfeeding
Is my baby getting enough milk? (continued)
Remember
• Your breasts may soften once your body has settled
into breastfeeding. This does not necessarily mean you
have a low supply. Your milk supply has settled to your
baby’s needs.
• Breast size has no relationship to milk production.
• Take care of yourself. Make sure you eat regular healthy
meals throughout the day based on the five food
groups. Breastfeeding women require an additional
750-1000ml fluid/day on top of basic needs, so aim to
drink around 2½ litres (10 cups) of water a day. Try to
drink a glass a water at every breastfeed.
• Your baby can’t tell the time yet. In the first months
of life, babies don’t always become hungry at the same
time each day. Don’t feed on a schedule — feed
according to need.
• Breasts respond to frequent stimulation by producing
more milk. If your baby is sucking on a dummy or
a bottle, they won’t feed from you as often and your
supply will decrease.
• How often your baby needs to feed and how long they
take to feed differs a lot from one baby to the next.
• The more you feed, the more milk you make.
48
Common breastfeeding concerns
Sleepy or unsettled baby
In the first 6–8 weeks, there may be some special issues
that affect the establishment of breastfeeding.
Sleepy baby
Some babies are affected by:
• long labours or surgical intervention, causing
sleepiness in some babies
• anaesthetics and other drugs given during labour,
so they may be sleepy for long periods.
The first 72 hours are very important in the stimulation
of breastmilk. If a baby is fed well at least once in the first
day since birth there is no cause for concern. During the
day time if your baby does not ‘ask’ for a feed after about
5 hours, they can be woken and put to the breast. It is
recommended that your baby has a minimum of 6 (but
preferably at least 8–10) breastfeeds in 24 hours. It will
be easier to demand feed if your baby is in the same room
as you in hospital.
Try these ideas to help to stimulate your sleepy baby
and encourage them to feed:
• Allow skin to skin contact between you and your baby.
• Change their nappy.
• Express a little colostrum and give it by teaspoon,
syringe or cup to give your baby the ‘taste’ so they
will start seeking your breast.
• Unwrap your baby, talk to them and gently stroke
their legs and tummy.
• Stroke their lip and cheek.
• Cuddle your baby against your breast.
• If your baby is too sleepy to accept your breast when
offered, you will need to express your colostrum and
offer this to your baby. If your baby continues to be
sleepy and you are concerned, seek advice from
your GP or breastfeeding trained health professional.
• Jaundice may make your baby sleepy. Talk to your
health professional if you are concerned about
jaundice.
49
Common breastfeeding concerns
Sleepy or unsettled baby (continued)
Unsettled baby
Babies cry for many reasons. It is your baby’s most
powerful means of communication. Babies cry with their
whole bodies including their legs, so the normal leg
action of a baby is often misinterpreted as wind.
It is normal for babies to have at least one unsettled
period per day. It usually occurs in the evening but can
happen at any time. During these times your baby may
want to feed frequently and often seems to be snacking.
This often causes mothers to be worried about their milk
supply but that is rarely the cause of the problem. These
frequent feeds ‘put in the order’ for the next day and
should be welcomed as they will ensure your continued
milk supply. Do not offer formula as it will upset this
delicate balance. As you get to know your baby better and
they get to know you, you will develop skills to manage
these unsettled times better.
See ‘Is my baby getting enough milk?’ on page 47 if you
are concerned about your supply.
50
Regurgitation is common and may occur in about
40 per cent of babies under 3 months. Most babies with
regurgitation or reflux are healthy and grow well. By 6–10
months, as your baby spends more time during the day
in an upright position, the regurgitation usually settles.
Breastfeeding is not the cause and does not make
regurgitation any worse.
Breastfeeding does not cause colic or reflux.
Tip
• The process of winding wakens a baby into action for
the rest of the feed, but you do not have to wait for a
‘burp’ before continuing the feed or settling your baby
to sleep.
Common breastfeeding concerns
Common early problems — tender or cracked nipples
Tender nipples
Cracked nipples
Some nipple tenderness is normal at the start of feeds
in the first 1–2 weeks. After these early days, incorrect
attachment is the most common cause of nipple pain.
Tips
Tips
• Wash hands well before handling breasts.
• If you are using breast pads, change them when
they are wet.
• Avoid using shampoos and soaps on nipples.
• When you need to take your baby off your breast,
do it carefully by breaking the suction with your little
finger in the corner of your baby’s mouth.
• Expose your nipples to the air after each feed.
• Allow breastmilk to dry on your nipples after each feed
as it has properties that protect against infection.
• Generally avoid applying ointments, sprays, tinctures
and powders.
• Seek assistance from your child health nurse,
an Australian Breastfeeding Association counsellor
or other breastfeeding trained health professional.
• Poor attachment is the most common cause of cracked
nipples.
• Follow suggestions on this page for tender nipples.
• If it is too painful to breastfeed, avoid feeding on the
sore breast (for 12–24 hours) but express milk during
this period.
• Express milk by hand and feed the milk to your baby
in a bottle or cup.
• Gently remove breast pads to stop further damage
to your nipples. If the pad sticks to the breast, express
a little breastmilk to moisten it before trying to remove
it again.
• Put expressed breastmilk on nipples following feeds
to promote healing.
• Let your nipples air dry naturally.
• Research suggests the application of nipple cream
is ineffective in most cases.
51
Common breastfeeding concerns
Swollen breasts, blocked ducts, mastitis
Swollen breasts
Blocked milk duct
Swollen breasts in the first few weeks can be normal. It
can also happen when there has been a long separation
from the mother or when breastfeeding has been stopped
too suddenly. Some mothers get concerned that they have
too much milk. This is only a temporary problem and will
sort itself out as your body gets used to breastfeeding.
A blocked milk duct presents as a painful, swollen firm
mass in the breast and the skin over that area may be red.
If left untreated can lead to mastitis.
Tips
• Wear a comfortable, supporting bra that is not too tight.
• Take your bra off to feed when able and let the milk flow
freely from your second breast onto a towel.
• Massage your breasts gently during feeds.
• If your baby is having difficulty attaching, gently
express a small amount of milk to soften the areola (the
darker area around the nipple) before a feed.
• Demand feed your baby to keep your breasts
comfortable (8–10 feeds or more in 24 hours).
• If your breasts become painful, seek assistance
from a breastfeeding trained health professional.
52
Weaning is also a common time for swollen breasts and
mastitis. If your breasts become engorged when cutting
down the number of feeds, you may need to express a
little for comfort to prevent the risk of mastitis. Too much
expressing may stimulate further milk production.
Tips
• Feed your baby as often as possible, starting with the
affected breast.
• Gently massage the lump towards the nipple while
your baby is feeding to help clear the blockage.
• Start each feed on the affected side for 2–3 consecutive
feeds to help the breast drain. Then offer the second
breast or express for comfort.
• To improve drainage of the affected area, it is best to
have your baby’s chin pointing towards the blocked duct.
• If your baby’s feeding has not reduced the lump, gently
massage toward the nipple while hand expressing.
• Apply warmth before and during a feed and cold
afterwards to the area. (A warm shower or a cool
compress can relieve pain or discomfort.)
• Check your bra is not too tight and remove during feeds
if you prefer.
• Sleep without a bra as much as possible.
• Positioning and attachment should be checked.
If a blocked duct persists for longer than 12–24 hours, seek
assistance from a breastfeeding trained health professional.
Mastitis
Remember
Onset of mastitis can be gradual or sudden and usually
occurs in one breast but may spread to the other.
Symptoms of mastitis include:
• inflammation of the breast
• Emptying of the affected breast by breastfeeding or
expressing is very important until infection has gone,
to reduce the chance of complications.
• Check your attachment is correct.
• hot, red, extremely painful area of the breast
• flu like symptoms, e.g. high temperature, headaches,
aching all over and generally feeling unwell.
Symptoms can include all or some of these points.
Tips
• Continue to breastfeed — mastitis is not a reason
to stop breastfeeding.
• Follow tips on page 52 for blocked ducts.
• Prompt treatment is essential. If you are experiencing
flu-like symptoms and fever see your GP immediately.
• Most antibiotics for mastitis are safe for the
breastfeeding mother. Talk to your GP or pharmacist
about your treatment.
• If you are not feeling better within 24–48 hours after
starting antibiotics, inform your Doctor.
• Rest and plenty of fluids are important.
• Analgesia such as paracetamol or ibuprofen may
provide relief.
53
Common breastfeeding concerns
Breastfeeding when you are working or away from your baby
There may be many choices available if you are working
or away from your baby:
• Talk to your employer as early as possible, even
when you are still pregnant.
• Take as much time off work as you can.
• Work from home.
• Work part-time.
• Have someone bring your baby to you when she
or he needs a breastfeed.
• Use a child carer close to where you work so you can
go to your baby to feed.
• Express breastmilk while you are away and replace
the missed breastfeeds with expressed milk fed from
a cup or a bottle.
• For babies over 6 months, continue breastfeeding and
replace missed breastfeeds with appropriate solid
food. Offer expressed breastmilk or water.
• Replace breastfeeds while you are away from your baby
with infant formula and then continue to breastfeed in
the hours and days when you are not at work.
• Use night feeds to meet your baby’s need for comfort
and closeness.
54
Expressing breastmilk
• Wash your hands with soap and warm water. Dry hands
with a clean towel, single-use towel or air dryer.
• Find somewhere private where you can sit down, relax
and not be interrupted.
• Have all expressing equipment ready, clean and
sterilised.
• Encourage the milkflow by gently massaging the breast
– start from the top of the breast and stroke towards the
nipple, massage the underside too and repeat several
times to ensure that the whole breast is massaged.
Hand expressing
• Place thumb and fingers on opposite sides of your
breast just behind the areola (the darker skin around
your nipple).
• Rhythmically squeeze your breast with a rolling
movement between the thumb and fingers. Try about
twice per second. Be gentle especially if your breast
is very full.
• Drops of milk form on the nipple. Milkflow may soon
start and milk may spray. When the flow stops, move
your thumb and fingers around the areola so that all
the milk ducts are stimulated and drained.
• Change hands or breasts when you get tired.
Using a pump
Warming breastmilk
• Follow the directions that come with the pump.
• Stand the bottle of breastmilk in a container of warm
water for a few minutes (no more than 10 minutes).
• Ask whoever you got it from to show you how it works.
• It is often faster than hand expressing (should only take
around 10 mins) but you will not necessarily get more milk.
• Massage the breast towards the nipple while you are
using the pump. This helps to get the breastmilk out.
Use a warm washer to assist breastmilk to flow.
Storing expressed breastmilk
Pour the collected milk into a sterilised container and put
it in the refrigerator or into the freezer, making sure to
label with the date and time before freezing.
Breastmilk can be:
• refrigerated for up to 3 days (4°C or lower)
• stored without refrigeration (if needed) for 6–8 hours
if the temperature is less than 26°C
• frozen in the freezer section of a refrigerator with
a separate freezer door (-18°C) for up to 3 months
• Before feeding your baby, check the temperature of the
milk by letting a little drop onto the inside of your wrist.
It should feel comfortably warm or even a little bit cool.
(This is safe on unbroken skin.)
• Never microwave breastmilk.
• Discard any warmed milk that has not been used.
Transportation of breastmilk
• Use an insulated container (such as an esky) with
a freezer brick.
• If frozen milk remains frozen on arrival, put it directly
into the freezer.
• If some of the milk has thawed put it in the refrigerator
and use it within 4 hours. Do not refreeze it.
• If the milk has never been frozen you can either store
it in the refrigerator or freeze it.
• frozen in the deep freeze (-20°C or lower) for
6–12 months.
Always store breastmilk in the back of the refrigerator,
not in the door. Freeze milk that will not be used within 2
days. If your freezer is a compartment inside your
refrigerator, then only store the breastmilk for 2 weeks.
55
Common breastfeeding concerns
Breastfeeding when you are working or away from your baby (continued)
Using frozen breastmilk
• When needed, use oldest frozen milk first.
• Never refreeze thawed breastmilk.
• Frozen breastmilk can be thawed in the refrigerator
and used within 24 hours.
• Frozen breastmilk can also be thawed by standing in
a container of lukewarm water and using it straight
away.
• Only warm refrigerated breastmilk once and discard
any that is left over.
• Never microwave breastmilk.
Tips
• Sterilise the bottles and pumps by boiling, steam or
cold (chemical) sterilisation methods. See page 66 for
more detail.
• Leftover expressed milk from feeding should be
discarded.
56
Common breastfeeding concerns
When do I stop breastfeeding?
Breastmilk gives your baby all the nutrients she or he
needs for around the first 6 months of life. After this time
babies need solid food in addition to breastmilk.
Queensland Health, the National Health and Medical
Research Council and the World Health Organisation all
recommend that you continue breastfeeding until your
baby is at least 12 months old and for as long after that
suits both you and your baby.
As your baby gets older, you may experience the following
concerns. Here are some tips to help you to keep
breastfeeding:
Low supply
The more you feed, the more milk you will make. Offer the
breast between the usual feeds; offer the breast as a
comforter instead of a pacifier. Always feed from each
breast more than once each feed. Express milk between
feeds.
Teeth
Teeth may initially make the feed feel different but should
not cause any discomfort. Biting may occur at this stage
when your baby is getting used to and testing out her or
his new teeth. When this occurs, temporarily remove your
baby from the breast and return them when they are ready
to feed. Your baby will soon learn not to bite at feeding
time.
Distractions
As your baby gets older and more interested in and aware
of the surrounding world, he or she may frequently come
off during a feed to have a look around. You may need to
feed in a quiet room with fewer distractions.
Breast refusal
Babies can sometimes refuse the breast. This can be
one-off or repeated and is most often temporary. Causes
can be baby related (e.g. a cold, distractions, teething)
or mother related (e.g. hormonal changes, medications,
change in perfume). Try to find and deal with the
underlying problem. If refusal continues, contact your
child health nurse, an Australian Breastfeeding
Association counsellor, lactation consultant or other
breastfeeding trained professional.
Return of menstrual cycle
You may notice that your baby is a bit fussier with feeding,
however this will pass after the first few days of your
cycle.
Support and assistance
If you need assistance or support with any of these
concerns, refer to the sources listed on page 43.
57
Common breastfeeding concerns
When do I stop breastfeeding? (continued)
Tips for discontinuing breastfeeding
• Wean gradually — over several weeks or months,
depending on your comfort and your baby’s
acceptance.
• Be led by your baby and start by weaning the feed they
are least interested in.
• If your baby is 6 months or younger, replace missed
breastfeeds with expressed breastmilk or infant
formula.
• For babies over the age of 6 months, you may choose to
wean onto a cup rather than a feeding bottle and
encourage cessation of bottle use by 12 months.
• If your baby is older, the foods or drinks you could
replace feeds with depend on your baby’s age. Refer
to the sections on "Introducing solid foods" in this
booklet (beginning on page 68) for the different age
groups.
• If your breasts become engorged, try to resist
expressing milk as you do not want your supply to
increase. Express just a little for comfort and to reduce
the risk of mastitis.
58
Common breastfeeding concerns
Drugs and breastfeeding
Drugs taken by a breastfeeding mother may pass from the
blood into the breastmilk, usually in very small amounts.
The extent to which this happens depends on a number of
factors, including the nature of the drug concerned, the
fat content of the breastmilk and the drug level in the
mother’s body.
Breastfeeding mothers can safely use most prescribed
medications. If you do need to take medications, always
check with your pharmacist or doctor before taking the
drug. This includes prescription and non prescription
items as well as vitamins, minerals, and herbal
preparations.
Recreational drugs are excreted into breast milk and may
be passed on to the baby. Contact your nearest Alcohol
and Drug Services for more information.
Use this booklet as ready reference to work out which
common drugs are safe to take. For further information
about the use of medicines/drugs in breastfeeding
contact the NPS Medicines Line: 1300633424
Maintain breastfeeding
Breastfeeding is the normal way to feed babies and has
many advantages for both you and your baby.
Its benefits are so important that breastfeeding should
only be discontinued if there is strong evidence that
a drug taken by the mother will harm the infant and there
is no alternative treatment.
Choose the right medication
If you need to take medications while breastfeeding,
discuss with your doctor about the safest option for you
and your baby. If required, your doctor will discuss the
risks and benefits of using the medication while
breastfeeding and have your therapy individualised.
Talk to a pharmacist for advice on the best time to take
your medications to minimise drug expose to your child.
Exposure in the womb
Babies are exposed to more medication in the womb than
through breastfeeding.
If you have been taking medications during your
pregnancy, make sure your paediatrician is aware. He/she
can monitor any potential side effects to your baby.
59
Common breastfeeding concerns
Drugs and breastfeeding (continued)
Drugs to relieve headache, aches, pain or
fever
Aspirin at doses used for pain relief should be avoided.
However, a once off single dose may be taken.
Breastfeeding mothers should try to avoid cold and flu
tablets containing pseudoephedrine and phenylephrine,
such as Sudafed® and Demazin®. That’s because these
agents can sometimes cause breastfeeding babies to
become irritable and restless. Pseudoephedrine can
also cause a significant reduction in milk volume.
Products containing codeine such as Panadeine,
Dymadon Co and Codalgin should only be used after
consultation with your doctor.
Try imidazole nasal spray decongestants instead,
like Sinex® and Otrivin®. Your pharmacist will be able
to identify these for you.
For period or muscular pain, you can take the above
drugs. As well, anti-inflammatory drugs such as ibuprofen
(Nurofen®, Actiprofen®) and diclofenac (Voltaren®) are
very effective, but should be taken in low doses for short
periods of time only.
Lozenges and gargles are safe for sore throats, though
it is best to avoid gargles containing povidone-iodine,
such as found in Betadine® and Viodine®.
Paracetamol, when taken as directed is quite safe to take
while breastfeeding. Common brand names for
paracetamol include Pandol, Dymadon and Panamax.
Creams and sprays available for muscle aches and pains
are safe to use.
Mefenamic acid (found in Ponstan®) and indomethacin
(e.g. Indocid®) are best avoided by breastfeeding
mothers. Other anti-inflammatory drugs such as
ibuprofen or diclofenac are preferred.
60
Cold, flu and asthma drugs
Most cough mixtures are safe, but avoid products
containing pseudoephedrine and phenylephrine.
Asthma treatment (e.g. puffers), should be the same
for breastfeeding women as for those who are not
breastfeeding, and is quite safe.
Hayfever and allergies
Contraception
There are some antihistamines on the market such as
loratadine (Claratyne®), fexofenadine (Telfast®) and
cetirizine (Zyrtec®) that do not cause sleepiness. Of these,
loratadine (Claratyne®) is the safest for you to use.
If you want to take the contraceptive pill while
breastfeeding, you should only be prescribed the
mini-pill. Common brand names include Microlut®,
Noriday®, Locilan®and Micronor®.
Older antihistamines such as dexchlorpheniramine
(Polaramine®), promethazine (Phenergan®) and
pheniramine (Avil®) may cause drowsiness as a side
effect and are better avoided. Use with caution while
breastfeeding and observe your baby for side effects
such as excessive sleepiness. Avoid sustained release
preparations (such as Polaramine Repetabs®).
Combined oral contraceptive pills – like Nordette®,
Microgynon®, Triphasil®, Triquilar ® and many others –
should not be taken.
Nasal sprays such as budesonide (Rhinocort®) and
beclomethasone (Aldecin® and Beconase®) are quite
safe.
The morning-after pill (Postinor ®) is quite safe for
emergency contraception.
Depo-Provera® and Depo-Ralovera® (both three-monthly
injectable contraceptives) are excreted into breastmilk in
very low amounts, and are also safe for use. They should
be given about 6 weeks after the birth.
Some implanted or inserted contraceptive devices (such
as Mirena®or Implanon®) are safe to use during
breastfeeding. You should discuss options, risks and
benefits with your doctor prior to implantation.
61
Common breastfeeding concerns
Drugs and breastfeeding (continued)
Constipation
If breastfeeding, the safest laxatives to use are fibrebased products, such as Metamucil® and Fybogel®,
followed by docusate (Coloxyl®).
Large doses of senna (as found in Senokot®, Coloxyl®
with Senna®, and Nulax®) or bisacodyl (Durolax®)
can cause diarrhoea in your baby.
Vitamins, minerals and herbal preparations
Many vitamin and mineral supplements are safe to use
during the breastfeeding period.
In fact, B-group vitamins in normal recommended
dosages may be particularly beneficial to mothers lacking
energy.
Be aware, though, that natural drugs like herbal
preparations may be natural but they may not necessarily
be harmless. Many herbal drugs contain chemical
substances that may be dangerous to the infant and
numerous poisonings have been reported in the past.
So if you are breastfeeding and want to take a herbal
supplement, check with your pharmacist, doctor or
child health nurse about its safety first.
62
For example, high doses of garlic can really irritate
breastfed babies, so it’s best to avoid garlic as
a supplement.
At all times, do not use more than the recommended
standard dose of herbal products, and use single
ingredient products rather than combination products of
unknown herbs.
Alcohol
The national alcohol guidelines recommend that if you are
breastfeeding, the safest option is not to drink alcohol.
When you drink alcohol it enters your breast milk and
within 30-60 minutes your breastmilk has the same blood
alcohol level as you do.
During the first years of life, your baby’s brain is still
developing at a very rapid rate and drinking alcohol while
breastfeeding can affect your baby’s brain development.
If you are breastfeeding and you choose to drink alcohol, try
to avoid alcohol in the first month after your baby is born
until breastfeeding is well-established. After that:
• alcohol intake should be limited to no more than two
standard drinks a day
• you should not drink alcohol immediately before you
breastfeed. There should be 2-3 hours between the
alcohol consumption and breastfeeding
• you should consider expressing milk in advance if you
want to drink alcohol.
Smoking
Illicit drugs
If you’re breastfeeding, you should try to stop or decrease
your smoking as much as possible.
Illicit drugs include illegal drugs — like marijuana, heroin
and amphetamines — and prescription drugs prescribed
for another person.
Smoking, apart from the adverse effects on babies,
has also been shown to reduce breastmilk production.
Quitting smoking is the best thing you can do for you and
your baby’s health. You can call Quitline 13 QUIT (13
7848) seven days a week for free information, practical
assistance and support.
If you are finding it difficult to quit, intermittent forms of
Nicotine Replacement Therapy like gum or lozenges are
safer than continuing to smoke. The Quitline can also
assist with this.
Mothers who use nicotine gum should try to use gum
immediately after breastfeeding to allow nicotine levels to
reduce before baby’s next feed.
If giving up smoking is not possible, you should reduce
smoking as much as possible, completely avoiding
smoking in the hour before feeding and during feeding.
No-one should smoke inside your house or your car or
outside near windows and doors as smoking is a known
risk factor for Sudden Infant Death Syndrome (SIDS).
* If you are having difficulty connecting it may be useful to dial
13HEALTH using only the first six digits of the phone number
(13 43 25). If you are still unable to connect to 13HEALTH then
please contact your service provider to discuss the issue.
You should avoid the use of illicit drugs or prescription
drugs prescribed for another person if you are
breastfeeding.
Recreational drugs are excreted into breast milk in varying
amounts, and are passed on to the baby.
Prolonged exposure to these drugs can also result in both
the mother and the baby becoming dependent on the
drugs.
If you are using illicit drugs, you should disclose this to
your health care professional so that they can assess
whether it is safe to breastfeed your baby.
ADIS (Alcohol and Drug Information Services) is a
confidential 24/7 telephone counselling, information and
referral service for those struggling with alcohol and drug
use. 1800 177 833
For more information
Keep this booklet as a handy reference.
If you want more details, talk to your pharmacist, doctor
or child health nurse, or call the Medication Helpline on
1300 888 763 or 13 HEALTH (13 43 25 84*).
63
Formula feeding
Bottle feeding
If breastfeeding is not possible, the use of a commercial
infant formula is recommended. Cows milk-based formula
is suitable for most babies and is recommended over
formulas made from soy or goats milk. These and other
specialised formulas should only be used under the
advice of a health professional. Regular unmodified cows
or goats milk is not suitable for babies and should never
be given as a drink in the first 12 months.
Getting started
If your baby is formula fed, seek advice on formula from
your doctor, child health nurse or dietitian. In Australia, a
range of suitable infant formulas is available. It is
preferable to use a formula with a lower protein level. The
use of ‘follow-on formula’ for infants aged 6–12 months is
not considered necessary and no evidence has shown
advantages over using ‘infant formula’ It is recommended
to keep your baby on infant formula until 12 months of
age. After around 12 months you can introduce
pasteurised full cream milk.’
2. Wash your hands using soap and water and dry well.
Holding your baby close during feeding builds a close,
loving bond between you. Your baby can feel, smell and
see you, and this is when strong bonding between the
baby and the carer can develop.
64
Check the instructions on the formula container and
aways use the scoop provided with the formula being
used. Formula that is too strong will hurt your baby’s
kidneys; too weak and your baby won’t grow well.
1. Clean surfaces where formula will be made with a
clean cloth.
3. Clean and sterilise the bottle, teat and other feeding
equipment before you start (see page 66 on cleaning
infant feeing equipment)
4. Boil fresh water and allow it to cool until luke warm
– to cool to a safe temperature, allow the water to sit
for at least 30 minutes.
5. Pour the required amount of cooled, boiled water into
the sterilised bottle.
6. Add the required number of scoops of formula to the
water. The scoop should be lightly tapped to remove
any air bubbles, then use a sterilised knife to level off
each scoop. Keep the scoop in the can when not in
use – do not wash the scoop as this can introduce
moisture into the tin if not dried adequately.
7. Place the teat and cap on the bottle and shake it until
the powder dissolves.
8. Before feeding your baby, check the temperature of
the feed by letting a little milk drop onto the side of
your wrist. It should feel just warm, but cool is better
than too hot.
9. Discard any formula that has been offered to your
baby and not been consumed within 1 hour. Do not
reheat half-empty bottles.
10. Hold your baby close and talk to your baby (if it is not
too distracting) while feeding and respond to your
baby’s cues – parent–infant contact is extremely
important
Do not leave your baby alone to drink the bottle. Do not
put your baby to sleep while drinking from a bottle – as
well as the risk of choking, this increases the risk of infant
tooth decay, ear infections and associated hearing loss.
Teats
Teats are available in a range of shapes and materials.
There is no evidence to support the benefits of particular
teats for problems such as colic (unsettled infants).
Several types of teats may have to be tried until a suitable
one is found.
All teats should be cleaned well with a bottle/teat brush
and sterilised correctly. Teats need to be checked and
replaced regularly.
Preparing feeds in advance
Ideally, prepare only one bottle of formula at a time,
just before feeding. If formula needs to be prepared in
advance it must be refrigerated (at 5°C or below) and used
within 24 hours. Alternatively, prepared sterilised bottles
of boiled water may be refrigerated and used as required,
first warming by standing bottle in a container of warm
water and then adding formula.
Warming formula
It is safe to give cool formula to babies; however most
babies seem to prefer to have it warmed.
• Refrigerated prepared formula should be warmed by
standing the bottle in a container of warm water before
feeding the infant.
• Do not use a microwave to heat infant formula, as
heating can occur unevenly and burn the infant’s
mouth.
• Formula should not be removed from the refrigerator
and warmed until immediately before feeding.
• Discard any formula left at the end of the feed. Any
formula that has been at room temperature for longer
than 1 hour should be discarded.
65
Formula feeding
Bottle feeding (continued)
Transportation of formula
• The safest way to transport formula feeds is to carry
individual portions of the powdered formula and the
cooled boiled water in separate sterile containers,
and make up the formula when required.
• Alternatively, the formula can be made up and
refrigerated (temperature no higher than 5°C) until
they are cold before transporting.
2. Wash teats and bottles in hot, soapy water using a
bottle brush and rinse well.
3. Place equipment (including bottles, teats and caps) in
a large saucepan on the back burner of the stove.
4. Cover utensils with water, making sure to eliminate all
air bubbles from the bottle.
• Do not remove the feed from the refrigerator until
immediately before transporting.
5. Bring to the boil and boil for 5 minutes. Turn off – do
not allow it to boil dry.
• Transport feeds in an insulated bag with ice bricks
and use within 2 hours. If you reach the destination
within 2 hours, place the feeds in the refrigerator at
the destination and use within 24 hours of the time
of preparation.
6. Allow the equipment to cool in the saucepan until it is
hand hot and then remove it – be very careful if
children are present.
Cleaning infant feeding equipment
8. Sterilised equipment can be stored in the refrigerator
for up to 24 hours.
(bottles and teats)
66
Boiling method
1. Wash your hands using soap and water.
Feeding equipment should be sterilised until the baby is
at least 12 months old. Thoroughly clean bottles and teats
manually or in a dishwasher. Bottles and teats can be
sterilised using boiling or steaming methods or cold
sterilisation. Use commercial steamers according to the
manufacturers’ instructions. Chemical sterilisers can be
used with cold water. It is a good idea to keep some
sterilising liquid or tablets on hand for emergencies.
7. Store dry sterilised equipment that is not being used
straight away in a clean covered container.
Cold sterilisation
1. Wash the bottles and teats with cold, soapy water.
Rinse with cold water.
2. Make up the sterilisation solution following the
manufacturer’s instructions carefully when making up
the solution to ensure the correct dilution.
3. Make sure all equipment is made of plastic or glass:
metal corrodes when left in chemical sterilant.
4. Completely submerge everything, making sure there
are no air bubbles, and leave it in the solution for at
least the recommended time – equipment can be left
in the solution until it is needed.
5. Use tongs to remove items from solution and shake
off excess liquid when you are ready to use a bottle
and teat. Use the bottle and teat immediately, do not
rinse solution off.
6. Discard the solution after 24 hours, thoroughly scrub
the container and equipment in warm water with
detergent and make up a new solution.
7. Store the sterilising concentrate and solution well out
of the reach of children.
How much formula?
Bottle fed babies should be fed on demand. Each baby
is different and needs vary from day to day. Refer to the
‘Is my baby getting enough milk?’ section on page 47 if
you are concerned about how much your baby is drinking.
The following can be used as a general guide:
• 1 to 4 days: Commence at 30–60 ml/kg bodyweight/
day and increase over the next few days
• 5 days–3 months: 150ml/kg bodyweight/day
• 3–6 months: 120ml/kg bodyweight/day
• 6–12 months: 100ml/kg bodyweight/day
It is important to be aware that there are many individual
variations in the amount of formula and the number of
bottles consumed each 24 hours. Information on formula
packages recommending certain amounts for various
ages is a guide only and does not necessarily suit every
infant. Plenty of wet nappies (six or more per day),
consistent (but not excessive) weight gain, and a thriving,
active infant indicate that all is well.
How to feed
Seat yourself comfortably and hold your baby in your arms
while giving the bottle. Hold the bottle tilted, with the
neck and teat filled with formula. If your baby does not
firmly grip the teat, gently press under their chin with your
middle finger and slightly withdraw the teat to encourage
sucking. This method will help to prevent your baby from
swallowing air, which can cause wind pain.
Check the bottle flow. When the bottle is upside down,
the milk should drop at a steady flow from the teat.
Sometimes the teat gets clogged when a powdered
formula is used. Check teats often.
Even when fed properly, a baby swallows some air. Hold
your baby upright over your shoulder or upright on your
lap with your hand supporting under their chin. Pat or rub
the middle of their back gently until they burp. If the baby
is feeding happily, don’t stop until they are ready! Watch
for signs that your baby has had enough.
67
Introducing solid foods
68
When and why
Food allergies
At around 6 months, your baby needs to start eating foods
other than breastmilk or formula. Baby's first foods and
other drinks are commonly referred to as 'solids'. It may be
the right time for your baby to start eating solids when:
• your baby can hold his or her head steady and can
sit on your lap with support
• your baby has progressed from sucking to biting
• your baby opens his or her mouth when you put
a spoon near it
• your baby can move smooth food from the front
of their tongue to the back, and swallow
• your baby’s appetite and nutritional requirements are no
longer satisfied by breast milk or infant formula alone
• your baby is starting to get interested in the world
around them, especially the food you are eating.
For good health, your baby needs to start eating solids at
around 6 months because his or her stores of iron and zinc
begin to fall and energy needs are starting to increase.
Introducing solids too early may make your baby sick, as
their digestive system has not developed enough.
Delaying introduction of solids beyond 6 months may
cause nutrient deficiencies, increase the risk of food
allergy, and may result in food refusal or fussy eating.
What is an allergy?
This is another opportunity to emotionally connect with
your child, so it is important to try to make it a positive
experience for everyone.
An allergy is an adverse reaction by the body to a foreign
material. Antibodies are produced and these cause the
allergic reaction.
There appears to be increased allergy risk with starting
solids early (less than 4 months) and late (after 7
months).
Symptoms of allergies
• Skin rash and swelling
• Abdominal pain and diarrhoea
• Vomiting
• Eczema
• Difficulty breathing or swelling of tongue*
• Becoming pale and floppy*
*
Serious reactions – call ambulance immediately.
Reactions can occur immediately (within seconds to
2 hours of eating) or may be delayed (may take hours
or days after eating).
Note: Food intolerance (an adverse reaction to food which
doesn’t result in the production of antibodies) and food
aversion (an avoidance of foods which may be based
on individual sensitivities) are not the same as allergy.
Allergies can be caused by factors other
than food
• It is difficult to identify problem foods when there are
other factors that could be causing the responses.
Allergies and intolerances are more common in young
children as their immune system is not yet fully
developed. Most will grow out of these responses.
• If food is found to be the problem, a decision must be
made as to whether dietary restriction is needed.
• Restricting dietary intake places the entire family under
great strain — nutritional, social and psychological
— and other treatments may be more realistic.
• Parents need to be realistic and seek advice before
changing their child’s diet.
It is important to get specialist help
You don’t want to unnecessarily restrict a child’s diet,
especially during periods of vital growth and
development.
Sensible precautions
There is insufficient evidence to support previous advice
to specifically delay or avoid potentially allergenic foods
(such as egg, peanut, nuts, wheat, cows milk and fish)
for the prevention of food allergy or eczema. This applies
to infants with siblings who already have allergies to
these foods.
If you have concerns, you should seek advice from your
health professional.
Most babies will not have any problems with new foods.
While children with a family history of allergy are at higher
risk of allergy, many children with no family history of
food allergy also develop allergy. Most children grow out
of their food allergies by adolescence. Parents should
seek advice if they are concerned.
69
Introducing solid foods
Feeding from around 6 months
How to start
• Choose a time when your baby is happy, you are calm
and have time to focus on your baby.
• Solid foods should supplement breastfeeding or
formula but not replace it. Continue to breastfeed or
formula feed as you were doing before you introduced
solids.
• Start with iron fortified infant cereal and/or iron rich
foods such as pureed meat or tofu, followed by other
foods from the Five Food Groups. Introduce different
tastes and textures as your baby grows.
• Make the food smooth and mushy by adding breastmilk
or formula. This may mean pureeing food with a blender
or pushing it through a sieve.
• Do not add sugar, honey or salt. Babies have very
sensitive taste buds and added salt can be bad for
their kidneys, whilst sugar can cause tooth decay.
• Offer 1–2 teaspoons after a breast or formula feed.
Slowly increase this to around 2 tablespoons.
• Start with offering solids once a day and gradually build
up to 3 times a day.
70
• Expect that your baby may refuse some new foods. This
is normal and it might take up to 30 times before your
baby learns to like some foods. Continue offering it at
other times and on other days.
• Respond to signs that baby is full – turning head,
refusing to open mouth. Never force baby to eat or
finish all the food in their bowl.
• Don’t put the spoon or food in your mouth before giving
it to your baby. Transferring bacteria from your mouth
can cause tooth decay.
• Cows milk should not be introduced as a drink until
12 months of age but can be added to food.
• Honey can cause infant botulism, a rare but serious
illness that can cause paralysis. It is not an essential
food and should not be introduced before 12 months.
Do not use honey as a sweetener on dummies or
bottles.
Breastmilk and formula feeds
Continue to breastfeed on demand or, if formula feeding,
aim for around 100ml/kg a day. Breastmilk or infant
formula is still your baby’s main food at this age.
Tips
• As soon as your baby’s teeth appear, brush them
with a child-sized, soft toothbrush. Introduce a small,
pea-sized amount of low fluoride toothpaste after your
baby turns 6 months in non-fluoridated areas and after
18 months in fluoridated areas*.
* Your dentist will be able to advise if your local water supply is fluoridated.
For more information on oral health, go to www.health.qld.gov.au/oralhealth
• Make sure the food you feed your baby is stored correctly
and prepared in a clean environment. Babies are very
sensitive to food poisoning. Keep prepared food in your
fridge for 1–2 days only. Prepared foods should not be
reheated more than once, and any foods served but not
eaten by your baby should be thrown away.
• Expect changes in your baby’s nappies as new foods
are introduced.
Sample menu 6–7 months
Breakfast
Baby cereal (1 tablespoon) mixed with breastmilk or
formula
Mashed fruit (½ tablespoon)
Yoghurt (½ tablespoon)
Breastmilk / 100 ml infant formula
• Drinking plain water is a good habit to start early.
Start to introduce cooled boiled water from a cup with
a spout. Soft drinks, cordials and tea are not suitable
drinks for babies. Fruit juice is also unnecessary.
Mid morning
• For convenience, prepare food ahead of time and freeze
it in ice cube trays or small individual containers for
later use.
Blended/mashed meat (1 tablespoon)
Blended/mashed vegetables (1 tablespoon)
Bread cut into pieces (½ slice) or pasta/rice (1
tablespoon)
Breastmilk / 100 ml infant formula
This is a really exciting time. It is not just about nutrition,
it's also about exposing your baby to a variety of healthy
foods to improve their acceptance of new flavours, and
sharing the enjoyment and social aspects of eating.
Check your baby’s growth regularly and make sure it is
recorded on the growth chart in your baby’s Personal
Health Record book. Continue to check that your baby’s
growth follows the pattern or curve of the graph. If the line
of growth curve is flat or moving downward at all or
upward crossing a number of percentiles, speak with a
health professional.
Breastmilk / 150 ml infant formula
Lunch
Mid afternoon
Breastmilk / 150 ml infant formula
Dinner
Blended/mashed meat (1 tablespoon)
Blended/mashed vegetables (1 tablespoon)
Pasta or rice (1 tablespoon)
Breastmilk / 100 ml infant formula
71
Introducing solid foods
Feeding from 7 to 12 months
By now your baby is eating pureed meats, baby rice
cereal, pureed fruit and pureed vegetables, as well as
breastmilk or formula.
Breastmilk and formula feeds
Continue to breastfeed or, if formula feeding, aim for
around 100ml/kg a day. Only expressed breastmilk,
fomula or water should be put in your baby’s bottle.
Babies can also be fed by a feeding cup from around
6 months. It is recommended that breastfeeding be
continued to at least 12 months and beyond. If your baby
is formula fed, 11–12 months is a good time to stop using
bottles and use a cup, but formula should still be used
until 12 months.
Foods to add in
• O
nce baby is managing to eat smooth food, vary the
texture of the foods from smooth, to fine mash, to
lumpy mash and minced food. Giving different textures
of food is good for jaw and speech development, and
can reduce the risk of later feeding difficulties.
• F oods should be offered three times a day, at routine
meal times, moving from after to before breastfeeds or
infant formula at around 9 months as intake increases.
72
• By 8 months your baby should also be able to eat a
range of finger foods in addition to lumpy foods, which
encourages self feeding.
• Accept mess! This is an important time for your baby to
experiment with food — let them touch it and self feed.
• Introducing a variety of foods at this age will make
refusal of new foods and feeding problems less likely
later on.
• Keep trying a variety of new foods from the five food
groups.
• Sugar or salt should not be added to food for babies.
• Fish: Cook fresh boneless fish well and check
thoroughly by feeling all the fish with your fingers for
bones. If using canned fish, use unsalted water-packed
fish.
• Avoid high sugar, fat or salty foods such as lollies,
sweet drinks, chips and savoury biscuits. These do not
help your baby grow well, and can lead to less room for
acceptance of healthy foods.
• Cooled boiled water, expressed breastmilk or formula
can be offered from a cup.
• Cows milk should not be introduced as a drink until 12
months of age but can be added to food.
• Foods with a high risk of choking such as whole nuts,
seeds, raw carrot, celery sticks and chunks of apple
should be avoided for the first 3 years as their size and/
or consistency increases the risk of inhalation and
choking. However nut pastes and nut spreads can be
offered to infants from around 6 months of age.
Tips
Planning meals from 7 to 12 months
• Serve freshly prepared food or food that has been kept
in the refrigerator for no longer than 1–2 days.
How much food is eaten at this age varies from child to
child and from day to day and is influenced by growth
and activity levels. These serving sizes and amounts
can be used as a guide to feeding your 7–12 month old
each day. Some serving sizes are different to those
commonly used for adults. While it is recommended to
introduce solid foods from around 6 months of age, it
may take around a month to reach these amounts.
• Sit your baby with the family at meal times to watch and
learn. Give your baby a spoon to hold too, even if you
are feeding them.
• The amount of food your baby needs will vary — provide
healthy foods and allow your baby to decide how much
they want to eat. Don’t expect them to always finish the
food on their plate. Use their growth and contentment
as a guide that they are getting enough.
The quantities in the following sample menu are a guide
only. How much babies eat varies a lot from one baby to
the next. Appropriate weight gain and development will
guide whether your baby is getting enough. Your baby’s
appetite may vary during growth spurts and teething.
Respond to signs of fullness and never force your baby to
eat — it is OK to have food left over on their plate.
Check your baby’s growth regularly and make sure it is
recorded on the growth chart in your baby’s Personal
Health Record book. Continue to check that your baby’s
growth follows the pattern or curve of the graph. If the line
of growth curve is flat or moving downward at all or
upward crossing a number of percentiles, speak with a
health professional
By 12 months of age, infants should be consuming a
wide variety of nutritious foods enjoyed by the rest of
the family.
Grains (cereal) foods
1½ serves a day
One serve = one slice of bread, or ½ medium roll or flat
bread or ½ cup cooked rice, pasta, noodles, porridge or
polenta, barley, buckwheat, semolina, cornmeal,
quinoa, bulgar, quinoa or 3 crisp breads, 1 English
muffin or scone or crumpet
Infant cereal (dried)
1 serve a day
One serve = 20g
73
Introducing solid foods
Feeding from 7 to 12 months (continued)
Vegetables and legumes/beans
Sample menu 7–12 months
1½ –2 serves a day
One serve = 20g cooked vegetables or legumes, fresh
vegetables are best but frozen and canned are also good
alternatives.
Breakfast
Fruit
½ serve a day
One serve = 20g fresh fruit is best but frozen and canned
(with no added sugar) are also good alternatives.
Lean meats and poultry, fish, eggs, tofu
1 serve daily
One serve = 30g cooked meat or 40g cooked chicken or
50g cooked fish or 1 egg or 85g tofu.
Mid morning
Breastmilk / 150 ml infant formula
Lunch
600ml
Blended/mashed meat (1 tablespoon)
Blended/mashed vegetables (1 tablespoon)
Bread cut into pieces (½ slice) or cooked pasta/rice (¼
cup)
Breastmilk / 100 ml infant formula
Yoghurt/cheese or alternatives
Mid afternoon
½ serve daily
One serve = 20g yoghurt or 10g cheese, choose full
cream varieties.
Dinner
Breastmilk or formula
For more information see www.eatforhealth.gov.au
74
Baby cereal (approx 3 tablespoons) mixed with breastmilk
or formula or full cream cows milk
Mashed fruit (1 tablespoon)
Full cream yoghurt (½ tablespoon)
Breastmilk / 100 ml infant formula
Breastmilk / 150 ml infant formula
Blended/mashed meat (1 tablespoon)
Blended/mashed vegetables (1 tablespoon)
Cooked Pasta or rice (½ cup)
Breastmilk / 100 ml infant formula
Introducing solid foods
Feeding from 12 months
Your child can now eat a wide range of family foods.
Foods to add in
• Full cream cows milk
• Regular (unboiled) water
This is a time for learning the social skills of eating
together as a family.
Encourage your child to feed themselves.
Do not force your child to finish all of their food.
• Infant formula can be replaced by full cream cows milk.
Limit cows milk intake to around 500 ml to leave
enough room for solid foods.
Your baby is now mobile and exploring and so will be
exposed to more infections. Making sure he or she is
eating healthy food will help protect against infection, as
will continuing to breastfeed.
Hints on preparing food for this age group
Give solids first before fluids.
Your child should now be eating and enjoying healthy
meals and meal times with the rest of the family. As much
as possible, offer ‘family meals’. Children do not need
special foods. If you need to, just modify the texture of
the food you are eating, e.g. cut up meats, or serve small
pasta pieces that are easy for your child to pick up.
Plan regular meal and snack times and allow enough time
for your child to eat a meal.
This is a great time for learning and exploring. Give
a variety of foods. Some foods won’t be well accepted
until your child tastes them 10–20 times. So be patient!
Do not add sugar and salt to basic foods.
Be consistent!
If food choices are limited or you have special diet needs,
seek advice from a dietitian, child health nurse or other
suitably qualified health professional.
Do not use food as a bribe or offer treats to force your
child to eat.
75
Introducing solid foods
Feeding from 12 months (continued)
Breastmilk and formula feeds
Continue to breastfeed as often as your child desires and
you are able. The use of formula or follow-on formula after
12 months is not necessary. Solid foods should provide
an increasing proportion of energy intake after 12
months. After 12 months, water and full cream cows milk
should be the main drinks offered, from a cup.
Frequent consumption of sugary drinks is associated with
increased risk of infant tooth decay. Fruit juice is also
acidic and can increase the risk of infant tooth decay and
erosion. It is especially important to avoid feeding these
drinks from baby bottles.
Planning meals from 12 months
There may be some variations in nutritional needs due to
growth and different activity levels. The servings listed
here provide a general guide for toddlers aged around 1–2
years. Appropriate growth and development will also
indicate whether food intake is at an appropriate overall
level for your child.
76
Grain (cereal) foods, mostly whole grain and/or high
cereal fibre varieties
4 serves a day
One serve = one slice of bread, or ½ medium roll or flat bread
or ½ cup cooked rice, pasta, noodles, porridge or polenta,
barley, buckwheat, semolina, cornmeal, quinoa, bulgar,
quinoa or 3 crisp breads, 1 English muffin or scone or crumpet .
Vegetables and legumes/beans
2–3 serves a day
One serve = ½ cup or 4 tablespoons of cooked vegetables or
legumes or 1 cup green leafy or raw vegetables.
Encourage your baby to taste and try a wide variety of both
raw and cooked vegetables. This is important in helping your
baby to develop healthy eating habits. Fresh vegetables are
best but frozen and canned are also good alternatives.
Fruit
½ serve a day
One serve = 1 medium apple, banana, orange or pear; or 2
small apricots, kiwi fruits, or plums; or 1 cup diced fruit; or
only occasionally ½ cup of fruit juice (no added sugar); or
30g dried fruit (4 dried apricot halves, 1½ tablespoons of
sultanas).
Fresh fruit is best but frozen and canned (with no added
sugar) are also good alternatives. Fruit juice is low in fibre
and dried fruit has high concentrations of natural sugar and
sticks to teeth, which can contribute to infant tooth decay.
Milk, yoghurt, cheese and/or alternatives
Breakfast
1–1½ serves a day
One serve = 1 cup milk or 200g yoghurt or 40g cheese or
½ cup ricotta cheese or 1 cup of soy, rice or other cereal
drink with at least 100mg of calcium per 100ml.
Breastfeed
Cereal with milk
Fruit
Choose full cream fat varieties, as reduced fat milk,
yoghurt and cheese products are not recommended for
children under 2 years. Continue to breastfeed on demand
for as long as you and your baby would like to.
1 slice toast or crackers with spread
Water
Lean meats and poultry, fish, eggs, tofu, nuts,
seeds, and legumes/beans
Meat/chicken/fish/egg/legumes
Vegetables (raw or cooked)
Bread or Pasta/rice/noodles(e.g. chicken or egg sandwich
with cucumber sticks and cherry tomatoes)
1 serve daily
One serve = 65g cooked meat, 80g cooked chicken, 100g
cooked fish or 2 eggs or 1 cup cooked or canned legumes/
beans or 170g tofu or 30g or nut or seed paste (peanut or
almond butter or tahini).
Red meat is an excellent source of iron. Try to include it
often. Nuts are not recommended for young children as
they may cause choking. Use only smooth nut pastes.
Mid-morning
Lunch
Mid-afternoon
1 small carton yoghurt
Water
Dinner
For more information see www.eatforhealth.gov.au
Meat/chicken/fish/egg/legumes
Vegetables (raw or cooked)
Pasta/rice/noodles
Sample menu 12 months
Supper
This sample menu gives an example of how these foods
could be eaten over the day.
Breastfeed/milk
Water is the best drink. Fruit juice is unnecessary.
77
Introducing solid foods
Suggestions
• mini muffins
There are many foods that toddlers often enjoy:
• beef patties
• shepherd’s pie
• diced fresh fruit
• macaroni cheese
• vegetable soups with pasta and cheese they sprinkle
on themselves
• minced meat and pasta shells
• fish or chicken fingers
• foods where they are involved in the preparation.
• ravioli
Vegetables may be better accepted if presented
separately, so they can be identified. Try making them
into a face. Sometimes raw vegetables are accepted
better than cooked.
• risottos and pastas made with vegetables
• diced meats
• cheese
• food cut into different shapes, e.g. melon balls,
use biscuit cutters for different sandwich shapes
• pikelets
• little fruit and vegetables, e.g. cherry tomatoes, grapes
• noodles
• spaghetti and all different shapes of pasta
• boiled or scrambled egg
• potato patties
• home made pizza fingers
• mini chicken drumsticks
• meatballs
78
• baked beans
Try varying the way you serve a vegetable to improve its
acceptance, e.g. mashed potato might be more popular
than boiled potato. Grated carrot in a bolognese sauce
might be eaten when carrot pieces aren’t.
Remember
• Food can be simple. It does not need to be complex.
• Adapt family food to suit your baby’s developmental
stage.
• If you are using commercially prepared food, start with
single ingredients such as apple or sweet potato. Only
use commercially prepared food sometimes as they do
not offer enough variety in foods and textures.
Introducing solid foods
Recipes for babies
When preparing food for your baby use a variety of foods
and avoid adding salt, sugar or honey. Your baby’s taste
buds are more concentrated than ours and it is important
to develop a taste for the natural flavour of foods.
Babies and children do not need special foods. By
12 months your baby should be eating the same healthy
meals as the rest of the family. At earliest stages, the
easiest approach is to take part of your family meal and
change its texture to suit their developmental stage.
For example, from 6 months, a roast for the rest of the
family could become pureed potato, pumpkin and beans
for your baby with finely chopped and pureed meat
blended with meat juices. Children like to watch and
imitate people around them. This may be a time to
reassess your own food choices.
Expressed breastmilk, infant formula or cows milk may
be used in recipes for babies. All the recipes can be given
from 6 to 8 months depending on the developmental
stage of your baby.
As you become more confident feeding your baby, you will
be able to develop your own recipes. Here are some to get
you started.
1. Pureed vegetables
Ingredients
(finely chopped)
1 small potato, peeled
1 small piece pumpkin, peeled
½ cup carrot, grated
1 small piece green leafy vegetable
(broccoli, zucchini, lettuce)
Method
Using a steamer or saucepan, bring a small amount of
water to the boil.
Add the vegetables, cover with a tight fitting lid and cook
quickly until vegetables are soft.
Press vegetables through a strainer or puree in a blender
or food processor.
Offer the new food at the beginning of feeding time when
your baby is hungry. This will increase acceptance of new
flavours.
79
Introducing solid foods
Recipes for babies (continued)
2. Pureed fruit
3. Pureed meat with sweet potato
Ingredients
Ingredients
Fresh apple, pear, peach, apricot or dried prunes
(stones removed)
¼ cup of lean meat (e.g. chicken, beef, veal, lamb) – finely
chopped or minced
½ cup sweet potato – peeled and chopped
Method
If using fresh fruit, wash, peel, core and dice.
Method
If using dried fruit, wash, dice and soak in just enough
water to cover fruit for at least 15 minutes before cooking.
Place meat and sweet potato in a saucepan with enough
water to cover. Simmer gently until tender and well
cooked.
Place fresh fruit or soaked, dried fruit and any remaining
liquid in a saucepan. Add just enough water to cover the
bottom of the saucepan and cook quickly until fruit is
soft.
Press pulp through a strainer or puree in a blender.
Press through a sieve or blend to a smooth consistency
and serve.
4. Rusks
Ingredients
1 loaf unsliced wholemeal bread
Method
Cut about 4cm of crust from all sides of bread. Cut crusts
into fingers.
Spread crusts over a baking tray and bake in a slow oven
for approximately 1 hour until dry.
80
Allow to cool, then store in an airtight container in
the refrigerator. Use as required. Store for a maximum
of 1 week.
5. Pureed steamed fish
7. Milk custard
Ingredients
Ingredients
1 fillet of fish
1 tablespoon cornflour
250ml milk
½ teaspoon vanilla essence
1 tablespoon pureed fruit of choice
Method
Place fish in a steamer or saucepan with a small amount
of water.
Cover and steam until fish is well cooked.
Carefully remove all bones and skin and press through
a strainer or puree in a blender.
The fish may be served with white sauce from 9 months.
6. Banana rice pudding
Ingredients
¾ cup cooked rice
¾ cup (180ml) full cream milk
½ teaspoon vanilla essence
½ banana – mashed
Method
Place cornflour and vanilla in a saucepan and mix to a
smooth paste with a little milk.
Stir in the remaining milk.
Over medium heat, slowly bring to the boil, stirring
continuously for approximately for 10–15 minutes until
thickened.
Remove from heat, stir and pour into bowl.
Allow to cool slightly, then refrigerate to set.
Serve with the pureed fruit.
Method
Mix together the cooked rice, milk and banana.
Heat in a saucepan over low heat until milk is absorbed,
stirring frequently, then stir in vanilla.
Cool and serve warm or cold.
81
Introducing solid foods
Recipes for babies (continued)
8. Pureed chicken in white sauce
9. Scrambled egg
Ingredients
Ingredients
2 teaspoons flour or cornflour
½ teaspoon butter or oil
100ml milk
1 tablespoon finely chopped cooked chicken (no skin)
1 egg
150ml milk
Method
Over a gentle heat, blend flour and butter in a small
saucepan until a paste is formed.
Add milk gradually and stir continuously so lumps
don’t form.
Bring to the boil and keep stirring until a thick sauce
forms.
Add chicken and press through a strainer or puree
in a blender.
82
Method
Whisk egg and milk.
Pour mixture into a nonstick frypan and cook
over a low heat, stirring occasionally with a fork.
When cooked, cool slightly and serve.
10. Baked egg custard
11. Mince stew
Ingredients
Ingredients
1 egg
150ml full cream milk
½ teaspoon vanilla essence
1 tablespoon pureed fruit
¼ finely chopped onion
½ diced carrot
½ stick of celery finely chopped
¼ cup mince
Method
Method
Beat egg, milk and vanilla all ingredients together.
Saute onion in a little vegetable oil.
Pour into an ovenproof dish (approximately the size of 1
cup – 250ml). Stand in a baking dish containing enough
water to come halfway up the side of the ovenproof dish.
When onion is soft, add in carrot, celery and stir.
Bake in a moderate oven (180o C) for approximately
25–30 minutes or until custard is set
Add a little water if needed. This will also help
break up the mince and form a sauce.
When these vegetables have slightly softened,
add in mince and brown thoroughly.
Serve when warm or cold with pureed fruit.
83
Solids guide
From around 6 months
Food
Around 6 months
High iron foods (e.g. baby rice
cereal or pureed meat) made
up with expressed breastmilk,
formula or boiled water.
6 – 12 months
A variety of healthy foods
excluding choking hazards
(e.g. nuts, popcorn, lollies):
• soft/cooked vegetables
12+ months
A variety of healthy foods
excluding choking hazards
(e.g. nuts, popcorn, lollies):
• soft/cooked vegetables
• soft/cooked fruit
• soft/cooked fruit
• cereals, rice, pasta, breads
• cereals, rice, pasta, breads
• beef, lamb, veal, pork, chicken, • beef, lamb, veal, pork, chicken,
fish, legumes (e.g. lentils)
fish, legumes (e.g. lentils)
• full cream yoghurt, custard,
• full cream milk, yoghurt,
cheese and milk (milk only in
custard and cheese
food preparation not as a drink)
Flavourings • No added salt or sugar
• No honey
• No added salt or sugar
• No added salt or sugar
• No honey
• Honey is not necessary
Texture
• Start with smooth, pureed
• Move on to mashed foods, then • Move on to chopped
foods – start thin and gradually
minced and chopped foods, by
‘family’ foods
thicken
8 months most babies should
be able to manage ‘finger foods’
Drinks
• Breastmilk or formula
• Breastmilk or formula
• Cows milk / breastmilk
• Cooled boiled water from a cup • Cooled boiled water from a cup • Formula is not necessary
• Fruit juice is not necessary
84
• Fruit juice is not necessary
• Regular (unboiled) water from a
cup
• Fruit juice is not necessary
Physical Activity
Physical activity from birth to one year is important for
health. It is important for you to make time to play with
your baby.
Recommendation
For healthy development in infants (birth to one year),
physical activity, particularly supervised floor-based play
in safe environments, should be encouraged from birth.
Active daily play will:
• keep their body and mind active
• develop strength and balance as well as movement
patterns and motor skills
• make them feel happy, loved and safe
• teach them about their body and the world around
them
• encourage interaction with others.
Physical activity before your baby can walk involves
letting your baby move around freely on their tummy and
back in safe environments every day. It also involves
practising pulling, grasping, reaching, pushing, and
playing with other people, objects and toys. Help your
baby get comfortable with the world around them and
introduce them to the sounds, sights and feel of the
outdoor environment. But always remember sun safety –
see the sun protection tips on the next page.
Tips
• Place different things in your baby’s play environment
to encourage different kinds of movements, for
example, building a tunnel for the baby to crawl
through or introducing a sturdy bench for them to pull
themselves up on.
• Do not use baby walkers and baby exercise jumpers.
The evidence shows they can restrict the muscle
development required for independent walking and
may cause injuries.
• Provide your baby with objects that make different
sounds, or play them music.
• Give your baby toys and place them in environments
that introduce them to different textures to help
develop their sense of touch. For example, read to them
from cardboard and felt books, and place them on rugs
and grass.
• Show your baby moving objects by playing ‘peek-a-boo’
or placing them below a colourful mobile that they can
‘follow’ with their eyes, to help develop their eye
strength and movement.
• Avoid keeping your baby restrained for long periods
in a car, high chair, car seat, porta-cot or stroller.
85
Physical Activity
No screen-time
Sun protection
No Screen time
• B
aby’s and young children’s skin is very sensitive and
susceptible to sunburn. Infants under 12 months
should not be intentionally exposed to direct sunlight.
Children younger than 2 years of age should not spend
any time watching television or using other electronic
media (DVDs, computer and other electronic games).
Why no screen-time from birth to 2 years?
• It may reduce the amount of time your baby has for
active play, social interaction with others and chances
for language development.
• It may delay the development of language.
• It may reduce the length of time they can stay focused.
For more information
• Department of Health and Ageing:
Get Up & Grow: Healthy Eating and Physical Activity
for Early Childhood resources
www.health.gov.au
• Department of Health and Ageing:
Physical Activity Recommendations for Children
0-5 years
www.health.gov.au
86
• Plan your daily activities to ensure your baby is well
protected from the sun, try to schedule outdoor
activities for the early morning or late afternoon.
• U
sing physical/barrier protection methods such as
shade, clothing and broad brim, bucket or legionnaire
style hats are the best sun protection measures for all
babies and children. Ensure hat straps do not become a
choking hazzard.
• B
abies should not be exposed to direct or indirect
sunlight to treat nappy rash or neonatal jaundice, as
this puts them at high risk of sunburn and skin damage.
• A
pply a broad-spectrum SPF 30 or higher sunscreen
designed for children or sensitive skin on areas that are
not covered by clothing at least 20 minutes before
going outside and remember to reapply every 2 hours.
• Use sunglasses if practical to protect your baby’s eyes.
Infant sunglasses are available with soft elastic to keep
them in place.
Acknowledgements
Breastfeeding and infant nutrition
When your child is sick
The chapters on infant nutrition are consistent with
the National Breastfeeding Strategy 2010–15.
This section draws on information from:
• Giving Medication, The Centre for Community Child
Health, Royal Children’s Hospital Melbourne, 2005
Information is drawn from:
• Infant Feeding Guidelines, National Health and Medical
Research Council, 2013 www.eatforhealth.gov.au
• Breastfeeding and your baby, Queensland Health,
www.qld.gov.au/health/children/babies/breastfeeding
• Growing Strong: Feeding You and Your Baby, (for
Aboriginal and Torres Strait Islander families) Public
Health Queensland, Queensland Health,
www.health.qld.gov.au/nutrition/pregnancyindigenous
• Good start to life (for Maori and Pacific Islander children
and families) www.childrens.health.qld.gov.au/chq/
our-services/community-health-services/good-startprogram/
Thank you
This booklet is the result of input and effort from many
health professionals in Queensland. Their assistance
with the content for this booklet is greatly appreciated.
• Using Paracetamol or Ibuprofen, Children, Women's
and Children's Health Network – www.cyh.com
• Children - When to See the Doctor,
Better Health Channel – www.betterhealth.vic.gov.au
• Paediatric Fever Management, The Royal Children’s
Hospital Melbourne www.rch.org.au/kidsinfo/fact_
sheets/Fever_in_children/
• Parent Information About Children with High
Temperatures, Department of Paediatric Emergency
Medicine, The Mater Misericordiae Children’s Hospital.
This information is provided as general information only and should
not be relied upon as professional or medical advice. Professional
and medical advice should be sought for particular health concerns or
manifestations. Best efforts have been used to develop this
information which is considered correct and current in accordance
with accepted best practice in Queensland as at the date of
production.
The State of Queensland (Queensland Health) does not accept liability
to any person for the information provided in this booklet nor does it
warrant that the information will remain correct and current.
The State of Queensland (Queensland Health) does not promote,
endorse or create any association with any third party by publication
or use of any references or terminology in this booklet.
87
Notes
88
Useful contacts and websites
IN AN EMERGENCY, ALWAYS CALL 000 AND ASK
FOR THE AMBULANCE, POLICE, OR FIRE SERVICE.
Alcohol and Drug Information Service (ADIS)
1800 177 833 (free call) www.qld.gov.au/health/stayinghealthy/atods
Lactation Consultants of Australia and New Zealand
02 9431 8621 www.lcanz.org
Australian Breastfeeding Association
1800 686 268 (free call) www.breastfeeding.asn.au
Breastfeeding information (Queensland Health)
www.health.qld.gov.au/breastfeeding
Beyond Blue (pregnancy and early parenthood)
1300 22 4636 www.beyondblue.org.au
Children’s Health Queensland
www.childrens.health.qld.gov.au
Child Safety After Hours Service Centre
1800 177 135 (free call) / 07 3235 9999 (Brisbane)
DV Connect (domestic violence hotline) www.dvconnect.org/ Women: 1800 811 811 (24hr, 7 days)
Men: 1800 600 636 (9 am-12.00 midnight, 7 days)
Ellen Barron Family Centre
(parenting support service – by referral only) 07 3139 6500
www.childrens.health.qld.gov.au/ellen-barron-family-centre/
Immunise Australia Program
1800 671 811 (free call) www.immunise.health.gov.au/
Lifeline (24-hour hotline) 13 11 14 (free call) www.lifeline.org.au
Make Smoking History
Quitline: 137848 makesmokinghistory.org.au
PANDA (Perinatal Anxiety & Depression Association)
1300 726 306 (helpline) www.panda.org.au
Queensland Poisons Information Centre (24-hour hotline)
13 11 26 www.health.qld.gov.au/poisonsinformationcentre/
Queensland Centre for Perinatal and Infant Mental Health
07 3266 3100
Raising Children Network
www.raisingchildren.net.au
Red Nose (SIDS and Kids) (24-hour support line)
1300 308 307 www.rednose.com.au
True (Family Planning Queensland)
07 3250 0200 www.true.org.au/ (lists local clinics)
Australian Childhood Immunisation Register
Women’s Health Queensland Wide Inc
1800 017 676 (free call) / 07 3216 0376 (Brisbane)
www.womhealth.org.au/
1800 653 809 (free call)
13 HEALTH (24-hour health information and advice hotline)
Immunisation information (Queensland Health)
www.qld.gov.au/health/conditions/immunisation/
Kidsafe Queensland
07 3854 1829 www.kidsafeqld.com.au
6/2017
13 43 25 84 Ask for the Child Health Nurse
www.health.qld.gov.au/13health
Note: If you have difficulty connecting, try dialing only the first six digits
of the phone number (13 43 25).
www.facebook.com/childrenshealthqld
C
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