If one or both of a child's parents suffer from allergies, it is very likely that the child will also be affected. Allergy symptoms include eczema, hay fever and asthma, and are responsible for one-third of children's visits to the doctor. Fortunately, you can take steps to delay or reduce the severity of allergies in your child.

The American Academy of Pediatrics has developed the following recommendations for families with a strong history of allergies. If you need help deciding whether these apply to you, please talk to your baby's primary care physician to determine how likely it is that your baby may develop allergies.

1. Feed your baby breast milk exclusively for the first six months and through the first year or longer, if possible.

2. Eliminate certain foods from your diet. Peanuts and tree nuts, such as walnuts and almonds, should be avoided. Some mothers may also need to avoid eggs, cow's milk and fish. (Your baby's doctor can help you decide which foods to avoid based on your family history.)

Due to potential allergies, some women may choose to avoid peanuts during pregnancy.

3. Use a hypoallergenic formula. If you are not breastfeeding, or if you need to give your baby some formula in addition to breast milk, a hypoallergenic formula (such as Nutramigen or Alimentum), is a good choice.

4. Wait to start solid foods until 6 months of age. You may introduce solid foods after the first six months. However, your child should be 1-year old before trying dairy products, over 2-years old before eating eggs and over 3-years old before eating peanuts, nuts and fish. Your baby's doctor will help you decide which foods are appropriate at every age.

Below are helpful Web sites:

• American Academy of Pediatrics (www.aap.org)
  
• American Academy of Allergy, Asthma and Immunology (www.aaaai.org)
  
• 
  American College of Allergy, Asthma & Immunology (www.acaai.org)
  
• Food Allergy and Anaphylaxis Network (www.foodallergy.org)

NOTE: Lactose intolerance is not an allergy. Many adults stop making the enzyme lactase, which is necessary for digesting milk sugar (lactose), and may incorrectly believe they have developed an allergy to milk.

• How can I encourage breastfeeding skills when I use a bottle?
• How do I choose the right bottle?
• How can I make sure the bottle flows properly?
• When should I burp my baby?
• How much milk should I feed my baby?
• What should I do if I have further questions?

How can I encourage breastfeeding skills when I use a bottle?

• Place your baby in a sitting position in your lap so he or she can better control the flow of milk from the bottle. Avoid placing your baby on his or her back for a feed, as the flow from the bottle can be too fast and cause your baby to retract his or her tongue to control the flow − a pattern that would be counterproductive when breastfeeding.
  
  
• Hold your baby so that his or her neck is a little extended.
  
  
• It is very important to touch the bottle’s nipple to the center of your baby’s upper lip and wait until your baby opens his or her mouth wide, as if yawning, before starting the feed. If you give the bottle without asking your baby to open wide first, then he or she may not open wide for the breast.
  
  
• Hold the bottle as flat as possible so that your baby must actively draw milk from the bottle. A little air in the upper part of the nipple is OK.
  
  
• No matter what nipple you choose, your baby’s lips should be close to the nipple ring as he or she feeds. You do not want your baby sucking on only the tip of the nipple as this might cause him or her to also take a shallow position on the breast when breastfeeding.

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How do I choose the right bottle?

Dr. Brown’s standard (not wide-neck) bottle is an excellent starter bottle for most newborns. It is usually available at Planet Kids, The Right Start, Toys R Us and some large drug stores (check www.bestbottle.com for other locations). The nipple on this bottle is soft with a gently flaring shape, and the flow is usually just right. The 4-ounce size is ideal. However, a few babies may find the Dr. Brown’s flow too fast. You will see your baby gulp, choke and pull away repeatedly if this is the case. An alternative is the Playtex VentAire standard (not wide-neck) bottle. The nipple is almost identical to the Dr. Brown’s in shape and feel, but the flow is much slower.

Breastfeeding requires that the baby open his or her mouth very wide to latch deep onto the breast and maintain a wide-mouth position while feeding. Over the years many bottles have been introduced with wide, breast-like nipples but, sadly, they are usually quickly discontinued. For example, the Evenflo Elite has been discontinued but is still available at the Palo Alto Clinic pharmacy. Another wide nipple is the Gerber ComfortHold with the ComfortLatch nipple, and this is currently available and sold at many large drug stores and supermarkets. You can check www.gerber.com for retail locations.

The following nipples have a long, narrow "nipple" portion that may cause your baby to latch incorrectly at the breast if he or she sucks the narrow portion of these nipples instead of latching onto the base:

• Avent
  
• Playtex NaturalShape
  
• Playtex NaturaLatch
  
• Dr. Brown’s wide-neck

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How can I make sure the bottle flows properly?

Air has to flow into the bottle to replace the milk that has been consumed or a vacuum may form and make it impossible for your baby to draw out more milk. In response, he or she will fall asleep and not finish the feed.

In most bottles, air flows in under the ring that attaches the nipple to the bottle (it flows through the base of the VentAire and through a special vent in the Dr. Brown’s). Tighten the ring only enough to avoid leakage. Your baby should consume, on average, 1 ounce of milk (30 ml) every five minutes. Watch to see that your baby is swallowing after almost every suck.

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When should I burp my baby?

If your baby is feeding contentedly, there is no need to interrupt the feed in order to burp. At the end of the feed support him or her upright against your chest and pat very gently for a few minutes. Babies do not always burp.
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How much milk should I feed my baby?

Put at least half an ounce more milk in the bottle than you expect your baby to drink. Room-temperature milk is fine. Your baby’s doctor will give you an intake goal, which is often 16 to 20 ounces daily starting on day four. Do not limit your baby’s intake. Continue feeding until your baby refuses to suck and is content.
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What should I do if I have further questions?

If you have further questions about nipple confusion, breastfeeding or bottlefeeding, please call Lactation Consultant Joanna Koch, IBCLC, at 650-967-8715 for advice.

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