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
Sleepy or unsettled baby............................................................. 49
Bonding................................................................................................ 4
Common early problems — tender or cracked nipples....51
Keeping your baby safe........................................................ 5 Swollen breasts, blocked ducts, mastitis............................ 52
Safety advice for you and your baby.......................................... 5 Breastfeeding when you are working
Safe sleeping......................................................................................10 or away from your baby................................................................. 54
Immunisation..................................................................................... 13 When do I stop breastfeeding?.................................................. 57
Drugs and breastfeeding............................................................. 59
How your baby develops................................................... 14
0–3 months........................................................................................ 15 Formula feeding........................................................................64
3–6 months........................................................................................ 18 Bottle feeding.................................................................................... 64
6–9 months........................................................................................ 22 Introducing solids...................................................................68
9–12 months...................................................................................... 27 When and why................................................................................... 68
Taking care of your baby’s teeth............................... 32 Food allergies.................................................................................... 68
Feeding from around 6 months................................................. 70
Taking care of your baby's ears.................................. 34 Feeding from 7 to 12 months..................................................... 72
When your child is sick....................................................... 36 Feeding from 12 months............................................................... 75
Recipes for babies........................................................................... 79
Breastfeeding............................................................................. 39 Solids guide........................................................................................ 84
Best for baby and for Mum.......................................................... 39
Physical Activity....................................................................... 85
Getting started...................................................................................41
How do I start breastfeeding?.................................................... 44 No screen-time.................................................................................. 86
Is my baby getting enough milk?.............................................. 47 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 Your Personal Health Record ("red book") is essential for
to help answer some of the common questions parents keeping your child's records of health, growth,
and carers have about caring for their baby. developmental checks and immunisations. There are also
It covers the stages of your baby’s development from sections for you to fill in to help your health care provider
birth through to his or her first birthday, plus guidance better understand your child.
on feeding your growing baby. Take it with you whenever you take your child to any
Research has shown that a healthy start in life — including health care provider so they can record the visit, and so
good nutrition, a safe and secure environment, a warm other health care providers can see your child's health
and loving relationship with parents and carers, talking, check and immunisation history.
singing and playing in the first year — is the stepping
stone to a healthy life, right through to adulthood. Child Health Nursing Service
If you would like more information about your child’s Child and family health nurses are registered nurses with
development, health or nutrition, contact your child postgraduate qualifications and experience in child and
health nurse or your doctor. You can also sign up to family health nursing. Many child health nurses hold
receive free parenting news at www.raisingchildren.net.au. qualification in midwifery, and may be lactation
The list of emergency and helpful numbers at the back consultants and have extensive paediatric experience.
of this book will also point you towards further help. They are able to support families with key health
promotion interventions for children and families as well
Enjoy your first year of parenthood! as evidence-based prevention, health education and
anticipatory guidance.
Registering your baby’s birth
Your baby's birth must be registered with the Registry of To find your nearest Child Health Clinic, search at
Births, Deaths and Marriages (BDM). You will not be able www.qld.gov.au/health/children or call 13HEALTH
to get a birth certificate until this is done. For more (13 43 25 84)
* If you are having difficulty connecting it may be useful to dial 13 HEALTH
2 information see the back of the first tab in your child's using only the first six digits of the phone number (13 43 25). If you are still
PHR or visit BDM’s site at www.qld.gov.au/births. unable to connect to 13 HEALTH then please contact your service provider
to discuss the issue.
Parents' Evaluation of Development Status Playgroup
(PEDS) Playgroup Queensland provides opportunities for every
As a parent you know your child better than anyone else child to learn through quality play experiences while
does. You may notice things about your child that concern supporting parents and carers in their role as first
you – perhaps even things that no one else has noticed. It teachers. Find them on Facebook: Playgroup Qld.
is important that you share these with your health care
provider. Research shows that sharing your concerns Importance of kindy
about your child can help your health care provider It’s never too early to enrol your child in kindy. There is
understand your child better, and may also help pick up extensive evidence-based research demonstrating that
any problems early. PEDS is a set of 10 tested and reliable children's education and care affects their health,
questions that are included at 6, 12, 18 month, and 2½ wellbeing and competence throughout their lives. A
–3½ and 4-5 year visits. Queensland Government-approved kindergarten program
Please answer the questions in your Personal Health positively assists children with their emotional, physical,
Record book before each designated health check and social and intellectual growth and development.
discuss them with the health care provider during that
health visit to help them better understand your child.
Beyond the first 12 months
For information and factsheets on topics beyond the first
The first 5 years last a lifetime 12 months, visit the Raising Children Network site at
Research shows that up to 90% of a child's brain www.raisingchildren.net.au.
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.
3
 Bonding
Bonding with your baby • When your baby is upset, try to understand what this
For many parents, connecting emotionally with their baby may be like from their point of view and do what you
already started during pregnancy. However, the can to comfort them.
opportunity for parents and their baby to really get to • Talk to your baby often and try to put what your baby is
know each other and build a relationship begins after feeling into words. For example, “You’re so happy to be
birth. This is known as bonding and attachment. playing this game” or “Oh, it’s so sad to be hungry/
The baby's brain undergoes incredible development in the wet/lonely”.
first 1 to 3 years of life, so the experiences of a baby’s first • Name actions that you are doing e.g. when dressing
three years are critical to their physical, social and baby "One arm through, other arm, over your head !"
emotional progress. That is why a baby needs warm, Over time, this helps babies learn to predict what is
responsive, nurturing care from caregivers – it is through happening next
these relationships that a baby learns to become who
they are. For more information see raisingchildren.net. • Enjoy your baby while following their lead. This will help
au/articles/connecting_with_your_newborn.html. you both to build a sensitive relationship. For example,
if your baby grabs a new object, sit near them and
Here are some tips for this time. describe it.
• Remember that babies love faces and eye contact. • Not everyone falls in love with their baby immediately;
Spend lots of time sharing loving eye contact with your relationships build over time. Trust your own feelings and
baby, while being sensitive to when they need a break make sure you get support from family and friends or see
and may look away. Stay connected with them until a health professional if you feel like something is not right.
they turn their attention back to you. For example,
Looking after a new baby can be very demanding. Getting
comment saying “This is hard work, you are getting help early from family or professionals such as your GP,
tired, I will wait until you are ready”. Child Health Nurse or a counsellor if you experience
• Babies thrive on parents’ love and attention and enjoy distress, anxiety or depression can help to prevent the
lots of positive touch in these early days. Some might development of more serious issues for you and the
say “you will spoil the baby” but this is impossible relationship with your baby. For more information, contact
when you are responding to your baby’s needs. Parentline on 1300 30 1300 or link to 'New Parents' at the
4
Beyondblue website: www.beyondblue.org.au.
Keeping your baby safe
Safety advice for you and your baby
Injury is the leading cause of death among Queensland Caring for your baby
children. • Never leave your baby alone on change tables, chairs,
Queensland has one of the highest mortality rates for beds, tables, chairs or other high furniture.
childhood injury in Australia. Unfortunately, the home is • Hold your baby when feeding them a bottle, rather than
the most common place for children’s injuries to occur. propping them up. Babies can vomit or inhale milk and
As you care for your baby and watch them grow, keep holding your baby in an upright position will decrease
alert to all the ways children can unintentionally hurt the risk of ear infections and infant tooth decay.
themselves. The most common injuries are falls, drowning • Do not heat your baby’s bottle in a microwave oven.
(and immersions), burns and scalds, and poisonings. The milk can heat unevenly, risking scalding your
baby’s mouth.
It is important to realise that accidents are not inevitable
and, in fact, that most accidents can be predicted and • Never handle hot food or drinks, such as tea, coffee or
prevented. noodles, while holding your baby. Burns from hot water
and drinks can cause severe scarring to children.
The aim is not to wrap children up in cotton wool. After all,
exploring, taking risks and trying new things are all crucial • Make sure all caregivers are aware that a baby should
parts of children’s development. However, it is important never be shaken as this can cause brain damage or
to know where your child is at all times and what they are death.
doing. • Keep your baby out of direct sunlight. Use sun
protection methods, including: shade when possible,
To download a comprehensive child home safety
SPF30 or higher water resistant sunscreen, clothing
checklist, visit www.kidsafeqld.com.au. Reuse this
that covers as much skin as possible and a broad brim/
checklist each year as your child grows, develops and
bucket or legionnaires style hat. Sun protection
explores.
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 • If your baby has a dummy, check it:
is furry, remember babies can suck on the fur and -- is in good condition
swallow it.
-- has no ribbons or chains
• Toys should not have:
-- has holes in the plastic holder for quick,
-- dangling ribbons, long strings or elastic easy removal in an emergency
-- small or loose parts that can be pulled or chewed -- is only used to settle your baby and not put them
off to sleep.
-- squeakers that can be removed
• The use of a dummy after six months of age can
-- sharp edges or points increase the risk of ear infections and associated
-- rattles that can be taken apart hearing loss.
-- button batteries. • Remove any loose ribbons or trimmings on clothing
because they can choke your baby.
• Make sure teething rings can’t be pierced.
• Look inside mittens and bootees to make sure there
• All cuddly toys should be stuffed with old stockings, are no loops or threads that can wind around your
dacron or polyester. (Crumbled foam, beans and beads baby’s fingers and toes because they can cut off
can all be swallowed or pushed into ears or noses.) circulation.
• Remove all head covering before placing your baby
to sleep as they may overheat or become entangled.

6
Bath time • Wherever your child is playing, always look to make
• Always check the temperature of the water with your sure there are no objects within reach that are small
wrist or elbow before putting your baby in the bath. enough to swallow. As a guide, anything small enough
to fit inside a toilet roll is small enough for your baby to
• Never leave your baby alone during bath time —
swallow. You may need to look at the room from the
not even for a minute.
actual eye level of your child.
• Babies should never be left in the care of older children,
• Install smoke detectors throughout your home, check
no matter how reliable they seem.
them and change the batteries regularly. This will
• Check that your home has a properly functioning hot protect not only your baby but the whole family. Contact
water tempering device installed and set at the right your local fire service for more information.
temperature (50°C).
• Carefully supervise any interactions between your baby
Around your home and animals, especially dogs — particularly when dogs
Your baby is very mobile and eager to explore. Check are feeding, sleeping or with new puppies. Make sure
your house thoroughly and often to keep your baby safe. your baby is never left unsupervised near any family
• Button batteries are in many products, they are pets when at home or out.
extremely dangerous if inserted (nose, ear) or • As your child starts using their mouth to taste
swallowed. Identify items with button batteries in everything around them, be aware of the dangers of
them, secure the battery compartment, keep them out poisoning. Install a lockable cupboard, preferably up
of reach of children and dispose of them safely. If you high, in the kitchen, bathroom, laundry and garage to
think your child has swallowed or inserted a button store poisonous materials. Do not pour or decant
battery, immediately call the 24-hour Poisons chemicals into another container (especially food or
Information Centre on 13 11 26 for fast, expert advice. drink bottles).
• Always ensure your baby is strapped in securely when • Remove all alcohol from your baby’s reach (especially
in a bouncer, stroller or high chair. after a party). It only takes a small amount of alcohol
• Always keep one hand on your baby or toddler while to poison a baby.
they are on the change table. 7
 Keeping your baby safe
Safety advice for you and your baby (continued)
• Be aware that hand sanitiser often used in the nappy Out and about
bag does contain alcohol and is not fitted with a child • Every time your baby travels in a car they must be
resistant cap. Keep hand sanitiser out of reach of rearward facing in an Australian Standard approved
children. baby capsule or child car restraint.
• Avoid smoking near your baby. Keep cigarettes, • Never leave your baby alone in the car — not even for
lighters, ashtrays and cigarette butts out of the reach of a minute.
children. Cigarettes and butts are poisonous to
• Baby must be unwrapped before being placed in the
children.
child car restraint, baby capsule, stroller or pram.
• Check your home has a proper electrical safety switch
• Do not use a sling/pouch that places the baby on their back
installed and operating to prevent electrocution.
in a curled ‘C’ position. Use an upright carrier that properly
• Every outside play area should be fenced off from supports the baby’s back, under the bottom and knees,
the street, pool/spa and driveway. On rural properties, high on the parent’s chest with face and nose uncovered.
a special fenced area away from any dams or Do not use a carrier while cooking or preparing food.
waterways should be set aside as the children’s
• Always know where your baby is before reversing
play area.
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.
• For more information call the Queensland Government
helpline on 1300 369 003, Kidsafe Queensland on
8 3854 1829 or contact your local ambulance station.
Effects of smoking on babies and children Children whose parents smoke are more likely to try
Babies and children are at a higher risk of damage from cigarettes and become regular smokers. Parents are role
passive smoking than adults because of their smaller models for their children, so setting an example by not
developing bodies, higher breathing rates and less smoking can reduce the likelihood of your children taking
developed respiratory and immune systems. up smoking.
Babies of mothers who smoke or who are exposed to Quitting smoking is the best thing you can do for you and
second-hand smoke are at increased risk of SIDS. your baby’s health. Quitline 13 QUIT (13 7848) provides
Smoking is one of the most important modifiable risk proactive support to pregnant mums and their partners
factors in reducing the risks of sudden infant death. through the Quitline’s Smoke-free Mums and Bubs
Smoking also increases the risks of babies developing program. This program involves a series of calls to get you
respiratory issues such as bronchitis and pneumonia as confidently on your way to a smoke free future.
well as regular ear infections and associated hearing loss.
Drinking alcohol after the birth of your baby
You can reduce your baby’s exposure to cigarette Alcohol can affect your coordination and reaction time
smoke by: and can cause drowsiness. When you or your baby’s carer
• keeping your car and home as smoke-free zones has these effects, your baby may be at increased risk of
• designating outside smoking areas away from open injury. The national alcohol guidelines recommend that
windows and doors, and using a smoking shirt over not drinking is the safest option when supervising or
your clothes caring for children.
• smoking after feeding your baby, not before
Drug use after the birth of your baby
• changing your own and your baby’s clothing often
Side effects from taking drugs may mean you are not able
during the day to remove contaminants
to respond to your baby’s needs as easily. If you or your
• not bed-sharing with your baby if you are a smoker baby’s carer is less responsive as a result of these effects,
• not smoking while you are pregnant. 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 • make sure the cot meets the Australian standard for
of sudden infant death: cots
• sleep baby on the back from birth, not on the tummy or • use a firm, flat, clean mattress that fits snugly in the
side cot
• sleep baby with head and face uncovered • ensure no additional mattresses or extra padding are
• keep baby smoke free before birth and after 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 • keep quilts, doonas, duvets, pillows, cot bumpers,
room as an adult care-giver for the first 6 to 12 months sheepskins and soft toys out of the cot or sleeping
• breastfeed baby if you can. place.
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 Bouncinettes, rockers, prams and strollers have NOT been
Tummy to play designed as sleeping products and therefore no baby
Sit up to look at the world.
should be left unsupervised if they fall asleep in these
environments.

10
Sleeping with your baby • As an alternative to bedding, an infant sleeping bag
In many families, the mother or father shares the same may be used so that your baby does not share the
bed or sleep surface as their baby. In some circumstances, adult bedding.
sharing the same sleep surface may increase the risk of • Do not ‘wrap’ your baby if you are sharing a sleep
sudden infant death. surface, as this restricts arm and leg movement.
SIDS and Kids recommends the safest place for a baby • Make sure your baby cannot fall off the bed. A safer
to sleep is in their own safe sleeping place in the same alternative is to place the mattress on the floor (but be
room as an adult care-giver for the first 6 to 12 months. aware of potential situations where your baby can
However, if you choose to share the same sleep surface become trapped).
with your baby, the following guidelines may make it • Pushing the bed up against the wall can be hazardous.
safer. Babies have died after being trapped between the bed
• Sleep your baby on their back from birth – never on and the wall.
their tummy or side. • Never place your baby to sleep in a bed with other
• If your baby lies on his or her side to breastfeed, he or children or pets.
she should be returned to the supine (back) position • Never leave your baby alone on an adult bed, or put
for sleep. your baby to sleep on a sofa, beanbag, waterbed or
• Make sure the mattress is firm and flat. soft, sagging mattress.
• Make sure that bedding cannot cover your baby’s face • Three sided cots that attach to the side of the bed are
or overheat your baby (use lightweight blankets and not safe or recommended. A four-sided cot with the drop
remove pillows, doonas and other soft items from the side down, positioned beside the bed, provides a safe
environment that could cover your baby). sleeping environment close to a parent during sleep.
• Sleep your baby beside one parent only, rather than • Sharing a bed with your baby while under the influence
between two parents, to reduce the likelihood of your of alcohol, a drug that causes sedation or alters your
baby becoming covered by adult bedding. level of consciousness, or when you are very tired,
• Ensure your partner knows your baby is in the bed. increases your baby’s risk of Sudden Infant Death
11
Syndrome (SIDS) and fatal sleeping accidents.
 Keeping your baby safe
Safe sleeping (continued)
Wrapping Strategies to reduce the risk of positional
For some babies, wrapping them in a lightweight cotton plagiocephaly (flattened area on the head)
or muslin wrap will help them to settle and sleep. developing
Wrapping is a safe and effective strategy to assist you • Place your baby on their back to sleep.
to settle your baby. • Change your baby’s head position every sleep.
If you choose to wrap your baby, make sure: • Have lots of tummy time when awake.
• your baby is placed on their back while wrapped • Regularly change the position of toys that your baby
• your baby’s face and head are not covered likes to look at.
• your baby is not overdressed under the wrap • Encourage your baby to turn his or her head to either
• the wrap is firm, not tight side when you talk or play with him or her.
• you modify the wrap to meet developmental changes • Put your baby to sleep at either end of the cot or
e.g. arms are free once ‘startle’ or Moro reflex begins reposition the cot to face a different direction.
to disappear (around 3 months of age) • Carry your baby in the upright position.
• your baby is not bed-sharing or sharing a sleep surface • Avoid prolonged periods in car seats, strollers, swings
with another person while wrapped. and bouncers.
When your baby can roll from their back to their tummy • Do not change to a softer mattress.
and then back again when you are watching them (usually • Do not change your baby’s sleeping position to a side
4–6 months), you can stop using the wrap for settling and or prone (tummy) position.
sleep. Wrapping them may stop an older baby who has
• Do not use a pillow or roll to keep your baby’s head
turned onto their tummy during sleep from returning to
in position.
the back-sleeping position.
• Do not use ‘sleep positioners’ or ‘wedges’ to keep baby
on its back or side.
For more information
Contact SIDS and Kids on 1300 308 307 or visit the
12 website rednose.com.au.
Keeping your baby safe
Immunisation
Immunisation is a simple and effective way of protecting Vaccines for parents and carers
children from serious diseases including meningococcal While babies are still too young to have completed the
C, measles, mumps, German measles (rubella), polio, full set of immunisations, the best way to protect them
Haemophilus Influenzae type B, whooping cough is by the parents and carers being immunised. This is
(pertussis), hepatitis B, pneumococcal disease, rotavirus, particularly important for whooping cough and influenza.
chickenpox (varicella), influenza, tetanus and diphtheria.
These diseases can cause hospitalisation, serious Whooping cough (or pertussis) is a highly contagious
ongoing health conditions (including cancer, brain disease spread by direct contact with infected nose or
damage and deafness) and are sometimes fatal. mouth secretions e.g. coughing, sneezing, sharing food or
kissing. Complications of whooping cough in babies
There is a strict timeframe for rotavirus vaccination and include pneumonia, fits, and brain damage from
no opportunity to catch up missed vaccination/s. Your prolonged lack of oxygen. It can be fatal in young babies.
baby’s vaccinations commence at 6 to 8 weeks of age and
rotavirus will be given at the same time as other vaccines. Whooping cough is most serious in babies who are less
than 6 months of age as they are not yet fully protected by
Refer to the schedule in your baby’s Personal Health vaccination. Most hospitalisations and deaths from
Record to keep track of when your baby’s immunisations whooping cough occur in babies less than 6 months of
are due and make sure you take the PHR with you age. Pertussis vaccination for people in close contact with
whenever you take your baby for vaccinations so the newborns is recommended and likely to reduce the risk of
Official Vaccination Record can be filled in. You might whooping cough in infants.
need this when enrolling your child in child care or school.
For more information
Vaccinate on time
Visit www.qld.gov.au/health/conditions/immunisation.
It is really important for your child to be vaccinated on Your doctor or immunisation provider will have the latest
time and according to the immunisation schedule. immunisation schedule.
Delaying or splitting vaccines on the schedule can
potentially expose your baby to dangerous vaccine Download the free VacciDate app from your app store to
preventable diseases. Your child isn’t fully protected if get reminders when each vaccination is due and to keep
records for every child in your family. 13
vaccinations become overdue.
 How your baby develops
Each baby develops at their own pace, usually through the Research shows that babies benefit from having active
same stages or milestones and in about the same order. play time every day. Aim to match play and movement
Babies grow and learn continually, but not always in with your baby’s age and stage of development. Avoid
smooth and flowing patterns. Sometimes they practise exposing your baby to the television and other screens.
skills for quite a while and seem as if they will never move
on. At other times they learn many skills very quickly.
Care for your baby
Your baby needs to feel loved, secure and safe.
What is important is that your baby is happy, safe,
growing and making progress. Helping your baby to develop a close relationship with
significant people in his or her life is a positive step
In the early weeks or at any time you have concerns about
towards achieving this.
your baby’s routine, keeping a record of your routines,
including feeding and sleeping routines, will assist if you As well, it is very important to avoid any family arguments
ever have concerns you would like to raise with your or violence around your baby as their emotional wellbeing
health professional. can be significantly affected. This will also help your baby
to feel safe
Understand your baby More information
Understanding your child’s developing abilities and what
If you would like more information about your child’s
they can and cannot do at each stage will help you to:
development or you are concerned about your child,
• keep your child safe
talk to your child health nurse or your doctor.
• help your child develop
You could also ask at your local library for books on
• understand your child’s behaviour child development or view a range of child health fact
• gain satisfaction and enjoyment from the important sheets at the Raising Children Network site, www.
role of caring for your child. raisingchildren.net.au.

14
How your baby develops
0–3 months
Your baby’s movements Feeding
Up to 3 months of age, most of your baby’s movements Breastmilk or infant formula is all the food your baby
are uncontrolled. needs until around 6 months. Your baby’s body is not
Babies have reflex movements, which they use for ready for solids before this time. Refer to the
survival. Some of these are sucking, sneezing and breastfeeding and infant formula feeding sections in this
swallowing. Some reflex movements — like throwing their booklet for more information.
arms out, stiffening and crying when they hear a noise — Tummy time
disappear after a short time.
Even though your baby should sleep on their back, it is
At 1 month important for them to have some ‘tummy time’ from birth.
At 1 month most babies: This can happen every day, when they are awake and you
are with them.
• turn their head and eyes towards light
• watch faces while being fed or talked to This will help your baby to develop essential movements
and skills like rolling, sitting, crawling and hand skills. It
• may smile to show pleasure.
also helps prevent plagiocephaly (see page 12).
Between 1 and 3 months At first, this can be following bath time when you are
Between 1 and 3 months most babies: drying your baby or during a massage time.
• become stronger If your baby cries or becomes distressed:
• lift their head and upper chest and may start • try tummy time for a shorter time but more often
using their arms for support when on their tummy • distract your baby’s attention by talking to your baby
• show an increasing awareness of people and using toys
• smile and coo to show pleasure • keep persisting!
• use joyful movements when expecting an enjoyable At a later stage — by 3 months — your baby should be
event, like a bath or feed time playing on his or her tummy when awake and you are
• settle to familiar sounds or voices, and are startled or with them. 15
jump when there is a sudden noise.
 How your baby develops
0–3 months (continued)
Your baby and other people If your baby’s needs are responded to, they will learn that
they are loved and wanted, and they will build a sense of
Language trust and attachment. If you have difficulty comforting
Babies develop skills for speech and language by your child, seek advice from your local child health nurse.
listening to the sounds around them. They also practise
making noises. Playing and learning
Talking, singing and reading to your baby will help them Your baby learns from every activity you do with them —
to develop their speech and language. Make these a part talking to them, changing their nappies, bathing, feeding
of every day. Bath times and nappy changes are good or just being close in the same room.
times for this. For babies, play is for learning and practising skills, as well as
In the first few weeks, babies may respond to adults exploring and finding out about their world and the people in it.
talking to them by altering their breathing pattern and by During the first 3 months your baby will learn to:
moving their mouth in response to seeing adults’ mouths • smile, chuckle and coo
moving during speech.
• turn towards sounds
Remember that when a dummy is in his or her mouth, it is
• look at and follow things with their eyes
not possible for your baby to practise making sounds for
later speech development. • reach out and touch things with their hands.

Crying Favourite play items

Crying is an important means of communication for young Favourite playthings for your baby at this stage include:
babies. They always cry for a reason. These reasons include: • attention from parents or caregivers
• tiredness • colourful mobiles, leaves or curtains blowing
• hunger 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
16 coordination of hands and eyes.
• parents’ anxieties (which babies quickly sense).
Safety possible and a broadbrim/bucket or legionnaire style
Make sure you are up to date with the safety hat. See page 86 for more sun protection tips.
recommendations on pages 5–9. • Every time your baby travels in a car, make sure you use
Young babies are helpless and their early movements are an approved baby capsule or child restraint. Not securing
uncontrolled so they are totally dependent on parents and your baby in a child car restraint or baby capsule will incur
carers for their safety. To help keep your baby safe, a fine in excess of $350 and 3 demerit points.
remember the following. • Never leave your baby alone in a car, not even for a
• Babies should never be left in the care of older children, minute.
no matter how reliable they seem. • Never leave your baby alone during bath time.
• All babies need to have their head supported until their • Look inside mittens, bootees and socks to be sure
neck muscles are strong enough to hold up their head. there are no loops or threads that can wind around your
• Hold your baby when feeding them a bottle, rather than baby’s fingers and toes and cut off blood circulation.
propping them up. Babies can vomit or inhale milk. • Make sure there are no objects around your baby which
Prop feeding can also increase the risk of ear infections are small enough for them to swallow, including small
and associated hearing loss. batteries and magnets.
• Do not heat your baby’s bottle in the microwave oven. The • Ensure that your baby is sleeping safely, according to
milk can heat unevenly, risking scalding your baby’s mouth. the guidelines on pages 10–12.
• Never leave your baby alone on a change table or other • Cigarette smoke is dangerous for your baby and no one
furniture (especially a bed), in the bath, in the car or should be smoking near your baby. Babies and young
near any family pets. children are very susceptible to the health effects of
• Always make sure your baby is unwrapped and tobacco smoke because their lungs and immune
strapped in securely when they’re in a pram, stroller or systems are still developing. Exposure to cigarette
shopping trolley. Always stay with them. smoke increases a child’s risk for developing ear
disease by 60 per cent. In Queensland you can be fined
• Protect your baby from sun and heat. Seek shade when
more than $250 if you smoke in a car with a child under
outdoors and use SPF30 or higher water-resistant 17
the age of 16 years.
sunscreen, clothing that covers as much skin as
 How your baby develops
3–6 months
Growth and development • will turn head or eyes towards interesting sounds
Between the ages of 3 and 6 months, most babies: • appear to listen
• will make eye contact with you and you will smile • wake easily to sound.
at each other
• become more alert and are attracted by brightly
Language
coloured or moving objects. They will look at curtains, Sounds are very interesting for babies at this age.
trees, shadows and mobiles They are beginning to babble and make some speech
sounds themselves.
• can bring their hands together over their chest and look
at them. Your baby can now reach out for objects, grasp You will help your child’s language development by doing
them and hold them in their hands the following:
• will dribble more as their mouths begin to produce • Talk and sing to your baby, even when you are doing
more saliva everyday things like changing a nappy, bathing or
feeding.
• become aware of other parts of their body, such as
chest, knees, genitals and toes. Slowly they learn ‘what • Observe if your baby is responding and hearing sounds
is me’ and ‘what is not’ as this is important when learning to talk.
• learn to roll over from tummy to back and back to tummy. • Smile and talk back to your baby whenever your baby
Their view of the world changes when they learn to roll. It makes sounds or smiles.
is easier and safer for your baby to learn new movements • Read and tell stories to your baby every day.
on the floor rather than on the bed or change table • Remember that when a dummy is in your baby’s mouth
• are developing skills for crawling. Tummy play will help it is not possible for him or her to practise making the
to develop strong neck and back muscles. This should sounds needed for later speech development.
be encouraged during every wakeful period • Repeat the sounds that your baby is making back to
• sleep less during the day, but probably a little more them and add new sounds as well.
at night • Make sure your baby can see, touch and feel your face
18 • are learning to sit with support 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 Practice makes perfect with babies.
during these 3 months. It is fascinating watching and helping babies learn about
They may be quiet, easygoing, impatient or demanding. themselves and their surroundings. If you give them the
Parents can feel differently towards each of their children opportunity, most babies will practise new activities until
and, since every child is unique, each child will react they can do them.
differently to each parent. From now on babies will explore things by holding, feeling
Most babies at this age are friendly towards everybody. and looking at them in their hands and putting them in
Babies can be easily distracted during feeding, but they their mouth. They will deliberately shake toys to make
usually manage to get enough food to stay healthy. noise.

Babies of this age like to gain attention by smiling and Babies of this age:
‘talking’, and will usually smile in response to your or • learn to sit with support
another person’s face or smile. • play with their toes
If your baby has been fed when hungry and comforted • are mobile (rolling, wriggling or crawling).
when upset, they will begin to develop a sense of security If you want to join your infant in their play it is often good
and trust. to follow their lead and play with what they want to play
with rather than directing their play.
Feeding
You might like to consider joining a local playgroup.
Breastmilk or infant formula is all the food your baby Contact Playgroup Queensland for a playgroup near you.
needs until around 6 months. Your baby’s body is not www.playgroupqueensland.com.au.
ready for solids before this time. Refer to the
breastfeeding and infant formula feeding sections in this
booklet for more information.
See page 68 for information on 'When and Why' to
19
introduce solid foods and other drinks.
 How your baby develops
3–6 months (continued)
Toys To keep your baby safe, remember the following
Make sure the toys you choose for your baby are safe, guidelines.
durable and washable by checking the safe toy guidelines • Babies should never be left in the care of older children,
on page 6. If toys are furry, remember babies can suck on no matter how reliable they seem.
the fur and swallow it. • Hold your baby when feeding them a bottle, rather than
Lots of practice helps to develop new skills. At this age propping them up. Babies can vomit or inhale milk.
babies need the following types of toys: Prop feeding can also increase the risk of ear infections
• bright, colourful objects within their sight and associated hearing loss.
• rattles or toys that are stretched across the pram • Never leave your baby alone on a change table or other
(within reaching distance) furniture (especially a bed), in the bath, in the car or
near any family pets.
• rattles and other objects of various shapes, sizes and
textures for holding and exploring, such as small rattles • Protect your baby from the sun and heat. Seek shade
for small hands, toys with bells, soft blocks or balls when outdoors and use SPF30 or higher, water-
resistant sunscreen, clothing that covers as much skin
• safe household objects
as possible and a broadbrim/bucket or legionnaire
• musical toys style hat. See page 86 for more sun protection tips.
• books • Every time your baby travels in a car, make sure you use
• toys on frames. an approved baby capsule or child restraint. Never
leave your baby alone in a car, not even for a minute.
Safety • Look inside mittens, bootees and socks to be sure
Make sure you are up to date with the safety there are no loops or threads that can wind around your
recommendations on pages 5–9. baby’s fingers and toes and cut off blood circulation.
Be aware that between 3 and 6 months, babies can move • Never leave your baby alone during bath time.
independently, pick up objects and put them in their
mouths.
20
• Make sure there are no objects small enough to As your child grows, they will become more mobile.
swallow in the area where your baby is playing. Pins, • Always make sure your baby is strapped in securely
batteries, small magnets, dead insects, buttons, when in a highchair, stroller or shopping trolley to
beads, nuts, coins and other small objects may cause prevent falls.
your baby to choke. Cigarette butts are poisonous to • Provide short periods in a playpen to help your baby
children. accept safety limitations later.
• Food can be inhaled easily when starting solids at • Check your home and garden for any poisons — or other
around 6 months. Do not offer your baby small, hard dangerous objects such as medicines — that could be
foods such as pieces of apple, carrot, popcorn or nuts eaten. Put away all chemicals and cleaners in the
(see ‘Introducing solid foods’ from page 68). kitchen, laundry, bathroom and garage into a lockable
• Ensure that your baby is sleeping safely, according to cupboard, high and out of reach. In the garden, remove
the guidelines on pages 10–12. mushrooms and any poisonous or irritating plants.
• Cigarette smoke is dangerous for your baby and no one Remember to discuss this with family and friends where
should be smoking near your baby. Babies and young your baby visits.
children are very susceptible to the health effects of If your baby has swallowed anything you think could be a
tobacco smoke because their lungs and immune problem or if you suspect your baby has inserted (nose or
systems are still developing. Exposure to cigarette ear) or swallowed a button battery immediately contact
smoke increases a child’s risk for developing ear the Poisons Information Centre on 13 11 26.
disease by 60 per cent. In Queensland you can be fined
more than $250 if you smoke in a car with a child under
the age of 16 years.

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 • begin to copy speech sounds
handle and explore things so they can learn more about • turn head to soft sounds.
their surroundings.
Everything goes into their mouth, even their feet. Feeding
At this age they: From around 6 months your baby is ready to start solid
foods with continued breastfeeding or infant formula
• grasp objects on sight
feeding, as explained in the breastfeeding and infant
• focus on near and far objects and follow them formula feeding sections in this booklet. See P68 for
with their eyes across a room information on 'When and Why' to introduce solid foods
• start trying to crawl. and other drinks.

By 9 months Your baby and other people

Babies will: Over the months, babies learn a lot about the people
• explore everything within reach around them. Between 6 and 9 months they:
• search in the correct place for hidden objects • recognise people they see every day
• watch toys fall from the pram or highchair onto the floor • are wary of strangers and less familiar people
• learn to roll easily from their tummy to their back and • enjoy communicating with familiar people using eye
then back to their tummy contact and facial expression.
• try to reach an interesting toy or object Babies may cry if their mother is out of sight even for a
• learn to sit without support short time because they cannot understand that she has
• start to move around on the floor (rolling, starting not left forever. Games like peek-a-boo help to teach
to crawl, bottom shuffle, etc.) babies that people and things exist even when they are
not seen. This is a normal stage in your child’s
• enjoy trying to eat with their fingers
22
development as they are beginning to know the difference
• start drinking from a cup (spilling is common) between familiar and unfamiliar people.
Learning through play Looking at books
Between 6 and 9 months babies develop further skills, Babies can’t concentrate for long, but they love to look
which they use when they play. at pictures and spend time with you talking about them.
Remember to choose a book that isn’t easily torn, has
Making sounds bright and clear colours, and has only a couple of simple
This includes shaking rattles, crumpling paper, objects on each page.
high-pitched squealing, laughing, joining sounds together
Making conversation
(ma-ma, da-da) and imitating noises they hear. You can
encourage this by repeating the sounds your baby makes This means listening to your baby and trying to
and adding new sounds as well. Remember that when understand their messages, as well as you talking to your
a dummy is in your baby’s mouth, it is not possible for baby. Talking to your baby and responding to their
him or her to practise making the sounds needed for later attempts to communicate will encourage your baby to
speech development. 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, Make sure you are up to date with the safety
useful toys include: recommendations on pages 5–9.
• bright, colourful objects, such as mobiles within your Babies from 6–9 months become very mobile as their need
baby’s sight to explore and learn about their world increases. Keep your
• rattles or toys stretched across the pram child safe by removing as many hazards as possible.
(within reaching distance) • Babies should never be left in the care of older children,
• rattles and other objects of various shapes, sizes and no matter how reliable they seem.
textures for holding and exploring, such as small rattles • Place your baby in a playpen for short periods each day
for small hands, toys with bells, soft blocks or balls to help them to understand and accept safety
• activity sets limitations later.
• bath toys • Never leave your baby alone on a change table or other
• small blocks — larger than a match box, as anything furniture (especially a bed), in the bath, in the car or
smaller could be a potential choking hazard near any family pets.
• safe household objects • Always make sure your baby is strapped in securely
when they’re in a highchair, stroller or shopping trolley
• musical toys
to prevent falls.
• pull-along toys
• Protect your baby from the sun and heat. Seek shade
• books when outdoors and use SPF30 or higher water-resistant
• balls. sunscreen, clothing that covers as much skin as possible
Make sure the toys you choose for your baby are safe, and a broadbrim/bucket or legionnaire style hat. See
durable and washable by checking the safe toy guidelines page 86 for more sun protection tips.
on page 6. • Every time your baby travels in a car, make sure you use
an approved baby capsule or child restraint. Never
24 leave your baby alone in a car, not even for a minute.
• Keep baby in a rear-facing child car restraint as long as tobacco smoke because their lungs and immune
possible – the road rule says 6 months but at least 12 systems are still developing. Exposure to cigarette
months is recommended. smoke increases a child’s risk for developing ear
• Babies can transition to a forward-facing child car disease by 60 per cent. In Queensland you can be fined
restraint when they have a strong neck – can sit on the more than $250 if you smoke in a car with a child under
floor unaided without toppling due to the weight of their the age of 16 years.
head – and when they reach the minimum height marker Your baby is very mobile and eager to explore. Check your
of the restraint. house thoroughly and often to keep your baby safe.
• Look inside socks to be sure there are no loops or • All low cupboards should have child-resistant latches,
threads that can wind around your baby’s fingers and and drawers should have locks to limit access to
toes and cut off blood circulation. poisons, medicines, cleaning products, knives,
• Never leave your baby alone during bath time. scissors and other dangerous objects.
• Make sure there are no objects small enough to • Be alert to your baby’s habit of wanting to taste
swallow in the area where your baby is playing. Pins, everything. Many things in the average backyard are
batteries, small magnets, dead insects, buttons, poisonous, including mushrooms, poisonous plants,
beads, nuts, coins and other small objects may cause pool and garden chemicals. All poisons should be kept
your baby to choke. Cigarette butts are poisonous to locked in a cupboard in the kitchen, laundry, bathroom and
children. garage, out of your baby’s reach. Remember to discuss
• Food can be inhaled easily when starting solids at this with family and friends where your baby visits.
around 6 months. Do not offer your baby small, hard • Inside the house, store medicines, cleaning aids and
foods such as pieces of apple, carrot, popcorn or nuts any sharp or dangerous items well out of reach, or in
(see ‘Introducing solid foods’ from page 68). a cupboard with a child-resistant latch.
• Cigarette smoke is dangerous for your baby and no one • Use safety barriers for steps, stairs and rooms you
should be smoking near your baby. Babies and young don’t want your child to enter, and to keep them away
children are very susceptible to the health effects of from fireplaces, swimming pools, heaters and spas.
25
 How your baby develops
6–9 months (continued)
• Check your home and garden for drowning hazards. • Dress your baby in nightwear made with fabric that
Place nappy buckets high, out of the way, with the lid is slow to burn or designed to reduce fire danger.
securely fitted. Keep bathroom and toilet doors closed. Look for the low fire risk danger rating on the tag.
It only takes 5cm of water and 2 minutes for a child to • Never leave your baby alone at other people’s homes
drown. Make sure the fence and gates for the swimming —especially where young children do not normally live
pool work properly and are never propped open. and where medication and other drugs may be stored
• Keep kettle and iron cords out of the reach of young within reach, such as on bedside tables.
children. Use stove and bench guards and curly cords • Ensure that your baby is sleeping safely, according
to prevent children from pulling hot food and drinks to the guidelines on pages 10–12.
onto themselves. Always turn saucepan handles to the
• On farms where there are waterholes, dams and creeks,
back of the stove. Do not leave hot drinks or food
fence the house with a self-locking gate.
unattended or within reach.
If your baby has swallowed anything you think could be a
• Cover power points when they’re not in use.
problem or if you suspect your baby has inserted (nose or
• Dangerous objects, like heaters and fans, should be ear) or swallowed a button battery immediately contact
kept out of reach. the Poisons Information Centre on 13 11 26.
• 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 baby jumpers (jolly
jumpers). They are not recommended or necessary for
healthy development of babies.

26
How your baby develops
9–12 months
Growth and development Your baby is becoming more skilled and they can use
From 9–12 months your baby will probably be able to: their fingertips for grasping and manipulating.
• sit unsupported for quite a time Because babies of this age can better control how they
• turn sideways without losing balance release objects, your baby can now stack blocks and put
objects into containers.
• stretch out to pick up a toy from the floor
They practise their throwing skills in a variety of ways,
• progress from rolling to wriggling to crawling on all
e.g. toys and food are thrown from strollers and high
fours. Some babies have their own crawling style which
chairs.
may not be usual, but their concern is getting
somewhere rather than how they do it Feeding
• pull themselves up to stand against furniture or Your baby does not need all food to be made smooth at
another support. At first when they pull up on a support this age. Introducing lumpy food before 9 months of age is
to stand up, they will not be able to lower themselves a critical window period to avoid the risk of later feeding
slowly back to a sitting position. They may flop down or difficulties.
cry for help, but will be back on their feet again in no Your baby can now chew – even if they don't have teeth
time yet. However, babies should not be given small, hard
• gradually walk by stepping sideways, using furniture foods such as pieces of apple, carrot, popcorn or nuts, as
for support they may choke on these.
• learn to walk when their two hands are held, then with Some babies will prefer to feed themselves with finger
one hand held foods but you will need to supervise. They will also enjoy
• possibly stand alone for a while, or even walk unaided trying to hold a spoon to feed themselves.
by 12 months. Many babies of this age are interested in holding and
drinking from a cup, so help them to do this when a drink
Use of hands is nearly finished, or use a lidded cup. Although this may
Your baby’s ability to use his or her hands is developing be messy, it will encourage your baby’s independence.
rapidly at this age. 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 At this age, your child is more confident with other people
sounds, especially voices — their own and other people’s. and enjoys the company of familiar adults, but:
During this time, they may say their first real word, • will sometimes object to new faces and voices
although it is often hard to hear it among the other noises • may be distressed if you leave, even for a short while
they make.
• will enjoy communicating with familiar people using
They love to: eye contact and facial expression.
• babble for amusement This is a normal stage of your child’s development as your
• show what they want by pointing and making sounds. baby is still learning to know the difference between
The more you talk to your child and respond to their familiar and unfamiliar people.
attempts to communicate, the easier it will be for their
language skills to develop. Learning through play
Playing is the way children learn about the world around
Babies learn language through lots of routine and
them. Lots of different types of play, suitable for the
repetition. Babies will understand what you are saying
child’s age, can give them the experiences needed to
before they begin to use words. So at this stage, using
develop and learn.
single words over and over will give your baby a chance to
hear words understand them and eventually copy them. Your child needs opportunities to explore and experiment
with new skills. You can provide these experiences by
When talking to your baby about things they express
playing with and talking to your child.
interest in, remember to get down to their level.
Games to play are:
Talking during everyday events, like changing a nappy
and bath time, helps to teach your child about language. • finger-toe songs and rhymes (e.g. ‘This little piggy’)
• peek-a-boo
Reading books and talking about the pictures is another
enjoyable way to help your child’s language skills. • clapping hands
28 • listening to and copying sounds.
At this age, useful toys include the following: Remember: The more a baby can crawl, walk, climb and
• cars and trains for • blocks and other explore, the greater the chance of injuries. This is also the
pushing stacking toys time when babies will use furniture to pull themselves up.
• nesting cups • peg puzzles Take care with top-heavy furniture (including flat screen
• activity sets • soft cuddly toys televisions), which can topple over if not secured.
• household containers • bath toys • Babies should never be left in the care of older children,
• non-toxic crayons and • medium to large balls. no matter how reliable they seem.
paper • Never leave your baby alone on a change table or other
furniture (especially a bed), in the bath, in the car or
You might like to consider joining a local playgroup.
near any family pets.
Contact Playgroup Queensland for a playgroup near you.
www.playgroupqueensland.com.au. • Always make sure your baby is strapped in securely
when they’re in a highchair, stroller or shopping trolley
Safety to prevent falls.
Make sure you are up to date with the safety • Protect your baby from the sun and heat. Seek shade
recommendations on pages 5–9. when outdoors and use SPF30 or higher water-resistant
sunscreen, clothing that covers as much skin as
A safe place for your baby to explore and play is essential. possible and a broadbrim/bucket or legionnaire style
From 9–12 months, babies can move around very quickly hat. See page 86 for more sun protection tips.
and quietly. They should not be left near windows,
• Every time your baby travels in a car, make sure you
balconies or on high pieces of furniture.
use an approved baby capsule or child restraint. Not
They don’t understand danger and can get into trouble securing your baby in a child car restraint or baby
before you know it — so you need to be very watchful. Check capsule will incur a fine of $341 and 3 demerit points.
your house thoroughly and often to keep your baby safe. It
• Keep baby in a rear-facing child car restraint as long as
is useful to get down to your baby’s eye level and move
possible – the road rule says 6 months but at least 12
about the home to identify any hazards.
months is recommended.
29
 How your baby develops
9–12 months (continued)
• Babies can transition to a forward facing child car restraint • Use safety barriers for steps, stairs and rooms you
when they have a strong neck – can sit on the floor don’t want your child to enter, and to keep them away
unaided without toppling due to the weight of their head from fireplaces, heaters, hot ovens, swimming pools
– and when they reach the minimum height marker of the and dams.
restraint. • Check your home and garden for drowning hazards.
• Never leave your baby alone in a car, not even for a Keep bathroom and toilet doors closed. Place nappy
minute. buckets high, out of the way, with the lid securely fitted
• Never leave your baby alone during bath time. — small children can fall into them head-first. It only
takes 5cm of water and 2 minutes for a child to drown.
• Make sure there are no objects small enough to
Make sure the fence and gates for the swimming pool
swallow around where your baby is playing. Pins,
work properly and are never propped open.
batteries, small magnets, dead insects, buttons,
beads, nuts, coins and other small objects may cause • Keep kettle and iron cords out of the reach of young
your baby to choke. Cigarette butts and even small children. Use stove and bench guards and curly cords
amounts of alcohol are poisonous to children. to prevent children from pulling hot food and beverages
onto themselves. Make sure saucepan handles are
• Place your baby in a playpen for short periods each day
turned to the back of the stove. Do not leave hot drinks
to help them understand and accept safety limitations
or food unattended or within reach.
later.
• Cover power points when they’re not in use.
• Cigarette smoke is dangerous for your baby and no one
should be smoking near your baby. Babies and young • Circuit breakers save lives and can be installed by
children are very susceptible to the health effects of an electrician.
tobacco smoke because their lungs and immune • Make sure all low cupboards have child-resistant
systems are still developing. Exposure to cigarette latches.
smoke increases a child’s risk for developing ear • Check that your furniture — like coffee tables — is
disease by 60 per cent. In Queensland you can be fined sturdy enough for your child to pull himself or herself
more than $250 if you smoke in a car with a child under up to stand.
30 the age of 16 years.
• Strap your TV to the wall or to a stable TV cabinet. • Do not use baby walkers or baby jumpers (jolly
• Ensure free-standing bookshelves, cupboards and jumpers). They are not recommended or necessary for
chests of drawers are secured to the walls. normal healthy babies.
• Do not place pretty objects or toys on the top of • Dress children in nightwear made with fabric that is
furniture that will encourage the baby to climb for them. slow to burn or designed to reduce fire danger. Look for
the low fire risk danger ratings on the tag.
• Store medicines, cleaning aids, detergents and any
sharp or dangerous items well out of reach, or in a • Avoid giving your baby any small, hard food to eat, like
cupboard with a child-resistant latch. pieces of apple, carrot, popcorn or nuts, as they may
choke on these.
• Dangerous objects, like heaters and fans, should be
kept out of reach. • Ensure that your baby is sleeping safely, according to
the guidelines on pages 10–12.
• Keep the bathroom door closed so your child can’t
touch the hot taps. Reduce the household water If your baby has swallowed anything you think could be a
temperature to avoid scalds and burns. Hot water problem or if you suspect your baby has inserted (nose or
regulators or thermostats should be fitted on all bath ear) or swallowed a button battery immediately contact
hot water taps. the Poisons Information Centre on 13 11 26.
• 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. 31
 Taking care of your baby’s teeth
About baby teeth and pharmacies and is often labelled as children’s
Healthy teeth allow children to: toothpaste.
• eat a nutritious diet Avoid rinsing your baby’s mouth or giving foods or drinks
• speak properly (including water) immediately after brushing. Discourage
• have a healthy smile. children from swallowing toothpaste.

Baby teeth also help to maintain the space for the adult Toothpaste should be kept out of reach of children, and
teeth. Early loss of a baby tooth can reduce the space not be dispensed by children.
for an adult tooth, resulting in crowding. Parents should assist with brushing of teeth until children
are around 8 years.
The timing of the 9 months
appearance of baby Fluoride
10 months
teeth can vary greatly. 18 months
Fluoride protects teeth against decay. Fluoride toothpaste
This diagram is a general 15 months and fluoridated water are effective ways to prevent tooth
guide to when baby decay. If your water supply is not fluoridated, seek advice
27 months
teeth should appear. on options from your dentist*.
Taking care of teeth Teething problems
Clean your baby’s teeth as soon as they appear. Do this
Some babies and toddlers may experience teething
twice daily as it is important to remove the plaque (a
problems such as:
sticky film of bacteria) that can cause decay (holes).
• red, swollen gums • irritability and restlessness
Start by using a child-sized, soft toothbrush moistened
• flushed cheeks or fever • dribbling
with water. If a toothbrush is not tolerated, a soft
wash-cloth can be used to wipe over teeth and gums for • finger and fist-sucking.
young babies. Mild teething problems may be eased by letting your baby
At 18 months, brush with a small (pea-sized) amount of chew on crusts of bread, rusks or teething rings. Rubbing
low-fluoride toothpaste, which is suitable for children your child’s gums with your finger or applying a small
32 under six. This can be purchased from most supermarkets amount of teething gel may also help.
* 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
What is infant tooth decay? How to prevent infant tooth decay
Infant tooth decay can start as soon as teeth appear. • Breastfeeding is best for your baby.
Decay looks like brown or white spots on the teeth that do • Only put breastmilk, formula or water in your baby’s
not rub off. It can cause pain and stop young children from bottle. Sugary drinks and juice cause tooth decay.
eating well.
• Avoid leaving your baby alone to drink a bottle and avoid
Avoid giving children bottles that contain sugary drinks, putting your baby to bed with a bottle.
such as juice, cordial and soft drink as this causes infant • Do not sweeten or flavour a dummy before placing in
tooth decay. Putting an infant to bed with a bottle your child’s mouth. Check the dummy regularly for rips
increases the chance of tooth decay. Tooth decay is less and tears and replace it if these are found.
common in breastfed babies.
• Don’t put anything in an infant’s mouth if it has been in
Have your baby’s teeth checked by a dental practitioner someone else’s mouth.
before they turn two, or earlier if you have concerns. This • Try introducing a cup from about 6 months of age and try
check can be provided by a Child Health Nurse in some to stop bottle use from about 12 months of age.
areas.
• Clean your baby’s teeth with a small, soft toothbrush as
Your oral hygiene could affect the oral health soon as they appear. At 18 months, start using
of your baby low-fluoride toothpaste.
Newborn babies do not have the bacteria (germs) in their • Look after the oral health of the family to reduce the
mouth that can cause decay. Parents and carers can pass chance of spreading decay-causing bacteria to your
on these bacteria to babies by sharing spoons, or by baby.
“cleaning” bottles or dummies in their own mouth. • Ensure your child has had an oral health assessment by
Looking after your own oral health will reduce the chance their second birthday.
of spreading decay-causing bacteria to newborns. Brush • Infant tooth decay is preventable. If you think your baby
twice a day with fluoride toothpaste and visit the dentist has infant tooth decay, or you would like additional
regularly. information about preventing it, contact your dental
practitioner. 33
 Taking care of your baby’s ears
Why is ear and hearing health important? testing by an audiologist before their 1st birthday. If you
Healthy hearing is critical to your baby’s speech and are unsure of the result of your baby’s newborn hearing
language development from the earliest months of life. screen or if they have a hearing loss risk factor, refer to the
Between one and two babies out of every 1000 will have a results recorded on the Healthy Hearing page in your
significant hearing loss. To identify babies who may be baby’s Personal Health Record book.
born with a hearing loss, all babies are offered a newborn If your baby passes their newborn hearing screen, hearing
hearing screen. Ideally, this screen is done before your problems can still arise. A hearing pass at birth is not a
baby leaves hospital after birth. pass for life and parents are encouraged to continue to
The newborn hearing screen gives a ‘pass’ or ‘refer’ result monitor their child’s hearing over the first 12 months.
for one or both ears. A ‘pass’ result in both ears means Hearing problems often arise from middle ear infections
your baby is unlikely to have a hearing loss that affects which is a common childhood illness. When a child has a
speech and language development. If your baby receives middle ear infection it can affect their hearing and they may
a ‘refer’ result in one or both ears, they will be referred to not turn to your voice or respond to loud noises. One ear
an audiologist for further testing to confirm if your baby infection in the first 12 months is not unusual but more than
has hearing loss and whether the hearing loss is three infections can lead to serious health concerns. Some
temporary or permanent. Ongoing support and treatment babies get frequent, severe and persistent middle ear
options are provided to all babies with temporary or infections which can lead to chronic ear disease and hearing
permanent loss based on the diagnosis they have loss. This will impact how they learn to talk, learn and play.
received. If your baby has a permanent hearing loss you
Chronic ear disease and associated hearing loss is a
will be referred to the Queensland Hearing Loss Family
particular concern for Aboriginal and Torres Strait Islander
Support Service for support and assistance.
babies and children. If your baby is Aboriginal and/or Torres
There are also some babies who pass the newborn Strait Islander it is recommended that you have your baby’s
hearing screen but have known risk factors for acquiring ears checked whenever they attend a health clinic. The health
some types of hearing loss that take longer to appear. If clinic can provide you with information on how to prevent,
this is the case, your baby will be referred for further identify and manage ear infections.
34
How to prevent and detect ear and hearing Signs and symptoms of middle ear disease in babies
problems include:
Middle ear infections are common but there are a number • signs of a cold (coughing, sore throat and runny nose)
of things parents can do to look after their baby’s ear and • pain in the ear
hearing health, including:
• runny fluid or pus from the ear
• breastfeeding their baby
• babies pulling at ears
• not smoking near their baby
• can’t hear properly
• ensuring their baby receives all their scheduled
immunisations • not eating
• ensuring people who play with the baby wash their • diarrhoea or vomiting
hands and faces before cuddling and kissing the baby • young babies being unsettled and hard to put down.
• using tissues when wiping their baby’s nose and
putting them in the bin and washing their own hands Healthy hearing checklist for babies:
• getting baby’s ears checked regularly by a child health Birth to 3 months • Settles to familiar sounds or voices
nurse, hearing health worker or doctor. • Is startled or jumps when there is a
Early detection gives babies and children the best chance sudden noise
for strong hearing to talk, learn and play. If your baby 3 to 6 months • Turns head or eyes toward
shows any of the following signs and symptoms of having interesting sounds
a middle ear disease or is struggling to meet the healthy • Appears to listen
hearing checklist, it is recommended you take your child • Wakes easily to sound
to see a health professional for an ear and hearing check. • Starts to make speech-like sounds
Formal hearing checks can be performed on babies at any 6 to 12 months • Understands simple words such as
age. For some babies, there will be no observable signs ‘no’ and ‘bye-bye’
and symptoms of middle ear disease, so ask your health • Begins to copy speech sounds
professional to check your baby’s ears every time your • Turns head to soft sounds
35
baby has a health check or visits the doctor.
 When your child is sick
It is very concerning for parents when their young children • Breathing difficulty — breathing may be noisy, rapid,
are sick. It is especially important to be able to tell the and/or shallow, or the child may take long pauses
difference between a serious illness and a minor one. between breaths. The baby may make a grunting
Parents also need to learn how to pick up the signs of sound, or the ribs or breastbone may be sucked in with
illness early so that treatment and care can begin as soon each breath.
as possible. This is especially important for very young • Poor feeding or loss of appetite — the baby or child may
babies and children, as their condition can deteriorate suck less vigorously, for shorter periods or refuse feeds
more quickly than older children. altogether. This needs to be taken seriously in an
infant. Taking less than half the normal amount of feed
Signs of sickness in a 24-hour period is of concern.
Most — but not all — illnesses in young children will be • Poor urine output — less than four wet nappies in a
accompanied by a fever (temperature above 37°C), but 24-hour period is a concern. This may be difficult to
not all children with a fever will be sick. assess if the child has diarrhoea. For an older child,
their urine will be reduced in amount and it may be
You will need to look at your child and ask yourself:
concentrated (a brown to orange colour).
• is my baby not feeding?
• Change in skin colour — the baby or child may be very
• is my child unhappy?
pale, have mottled skin, a rash or cold hands and feet.
• is my child lying around, not interested in playing or
• Change in poo — very loose poos, absent poos, signs of
their surroundings?
blood in poos or change in colour of poos may occur.
Other signs to watch out for if your child is unwell • Redness around the ears or discharge from the ears —
It is important, especially with babies and young children, the baby may be pulling at their ears because they are
to watch out for other important signs if they are unwell. experiencing pain or there is a visible discharge (runny
• Drowsiness and loss of interest in playing and fluid or pus) coming from the ear.
interacting with you — the baby or young child may be
less alert than usual and not interested in what is going
36 on around them. The child may prefer to just be cuddled
and may be ‘floppy’.
When to see the doctor Fevers
Seek medical attention — such as your local hospital A fever is where there is a rise in the body’s temperature.
or medical centre — as soon as you can if:
Fevers are the body’s natural response to fighting
• you observe any of the signs of sickness mentioned
infection. The infection responsible for producing the
previously, especially if a number of these occur
fever can be a virus or bacteria. It is sometimes difficult to
together
distinguish which is the cause.
• you have a very young baby whom you suspect is
unwell There are some important guidelines you should follow
• you are concerned about your child. if your child has a fever.
• Keep your child at rest and comfortable.
It is also important to seek help if your child:
• Remove excess blankets and clothing and keep the
• develops a rash
child lightly dressed.
• has a convulsion or fit
• Do not allow them to shiver as this contributes to a rise
• has a fever greater than 39°C (38°C if baby is less than
3 months) in temperature. If they do shiver, wrap them in a light
blanket until the shivering stops.
• vomits persistently for hours or vomits green fluid
or blood • If your child is under 6 months of age, give them extra
• has pain that is not relieved by paracetamol or breastfeeds, bottles or cooled boiled water. For older
ibuprofen children give frequent small drinks of clear fluid
• develops a lump or swelling — especially in the groin (including water or diluted fruit juice — one part juice to
• stops breathing for more than 15 seconds four parts water). A child with a fever will be thirsty
and, if they’re not vomiting, can drink as much fluid as
• has a severe headache, neck stiffness or light hurts
their eyes. they desire.
• Regularly check your child’s temperature with a
Further advice can be obtained by calling
thermometer — mercury and digital thermometers are
13 HEALTH (13 43 25 84*).
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. 37
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.
 When your child is sick
Medication Paracetamol
If your child generally seems well and happy, there is Follow directions on the bottle according to your child’s
no need to treat a fever with medication. age and weight.
However, paracetamol or ibuprofen can be given in the Dose can be given every 4–6 hours. Do not exceed 4
correct dose to treat a fever above 38.5°C if the child is doses within 24 hours.
irritable or in pain.
Ibuprofen (for example Nurofen® or Advil®)
Read the bottle carefully before giving your child a dose,
and talk to your pharmacist if you have any concerns. Follow directions on the bottle according to your child’s
age and weight.
Record doses given to keep track of medication use. This
is particularly important if there are two or more carers Ibuprofen should only be used in children over 3 months
(e.g. Mum and Dad) to make sure your child doesn’t of age unless recommended by your paediatrician.
accidently get an overdose. Precautions are required so contact your doctor or
pharmacist before purchasing and administering to your
Do not use paracetamol or ibuprofen for more than child.
48 hours without talking to a doctor.
Doses can be given up to every 6–8 hours. Do not exceed
Do not give aspirin to children without first seeking more than 3 doses in 24 hours. Give with food or after
medical advice. breastfeeding to reduce the risk of stomach upset.
Dosage
Remember
Multiple brands and strengths of medications are available
All children need extra care and attention when they
so always follow the guidance on the packaging for age and
are sick. Keeping them at rest and at home can be
weight for that particular medicine. If two different doses
important to recovery and will minimise the risk of
are recommended (one for weight, one for age) always give
transferring infection to other children.
the lowest dose recommended. Do not combine
medications unless advised by a health professional. Young children have no idea why they feel the way they
do when they are sick and will be irritable and upset.
38 If you think you may have given too much medication call
the Poisons Information Centre on 13 11 26. 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 Added advantages for your baby
babies — breastmilk. You can give your baby something Your breastmilk not only has all the nourishment that
that no one else can, and it’s natural, free and your baby needs, but it also reduces the risk of your baby
environmentally friendly. Breastfeeding gives your baby developing infections and diseases such as:
the best possible start in life. Support from family and • otitis media (e.g. ear infection), which can lead to
friends is a really important part of establishing and hearing loss
continuing breastfeeding.
• urinary tract infections
Breastfeeding is more than providing food for your baby. • gastrointestinal infections (e.g. diarrhoea)
Holding your baby close during breastfeeding builds
• atopic diseases (e.g. eczema, asthma)
a close, loving bond between you. Your baby can feel,
smell and see you. Breastfeeding helps build a special • inflammatory bowel disease
relationship with your baby. • some childhood cancers
Breastfeeding provides the perfect natural mix of • sudden infant death syndrome (SIDS)
nutrients that your baby needs in a form especially
designed for your baby’s maturing digestive system and • type 1 and type 2 diabetes
growing body. Breastmilk is made especially for your • obesity in childhood and in later life
baby. • heart disease in later life.
Like anything new, breastfeeding may take a little time to Breastfeeding also reduces the risk of your baby
get established. You may experience some difficulty in developing allergies and food intolerances, such
the early stages, but the advantages to both you and your as coeliac disease.
baby are worth it.
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 in public
• Breastfeeding helps your uterus return to its Mothers have the right to breastfeed in public places such
pre-pregnant state faster. as shopping centres, restaurants and public transport. It
• Breastfeeding can help you lose weight after your may be discrimination if staff or management try to stop
baby’s birth. you or tell you to move elsewhere.
• Breastfeeding lessens the likelihood of ovarian cancer For more information search for "Breastfeeding fact
and pre-menopausal breast cancer. sheet" at the Anti-Discrimination Commission website:
• Breastfeeding lessens the likelihood of osteoporosis. www.adcq.qld.gov.au.
• 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 What do I need to help me to breastfeed?
about breastfeeding. While your body has prepared itself for breastfeeding
during pregnancy, there are a number of things you can
When do I start breastfeeding? do which will help, especially in the early months.
Most babies are alert and have a strong desire to feed • Obtain breastfeeding information e.g. visit
after birth, so start as soon as possible. Hold baby close www.qld.gov.au/health/children/babies/
to you and most babies will start searching to feed within breastfeeding/ or www.health.qld.gov.au/
an hour or so of birth. Your body will have already breastfeeding or ask your midwife or doctor.
produced colostrum (baby’s first milk), which is perfect • Join a breastfeeding support group and talk to other
for your newborn baby. breastfeeding mothers.
How does my body produce milk? • Find out what breastfeeding support is in your area
before you leave hospital, e.g. child health clinic,
During pregnancy, your body begins to produce
lactation consultant, the Australian Breastfeeding
colostrum: a thick, rich, yellowish fluid. As you
Association and post-discharge services that support
breastfeed, the colostrum changes into mature
breastfeeding.
breastmilk. Breastmilk is never too rich or too weak. It
may look pale whitish blue as it changes to suit your • Try to sleep or rest when your baby is asleep.
baby’s needs, but it has all the nourishment necessary. • Accept offers of help with housework and meals from
your partner, family and friends. Let them know about
When your baby starts sucking, you may feel a tingling or
the benefits of breastfeeding so they can better
tightening sensation in your breasts. This feeling, known
support you.
as ‘let-down’ or ‘milk-ejection’, occurs at other times too
(e.g. when you hear your baby cry). Not all mothers feel • Do only essential housework.
their ‘let-down’ but watching the change in your baby's • Enjoy a wide variety of nutritious foods (see "What
sucking-swallowing pattern will show you it is happening. should I eat?" on the next page). Avoiding certain foods
will not prevent allergy development in children, nor
Breastmilk production works on supply and demand.
affect the baby's "wind". Try to keep physically active and
The more you breastfeed your baby, the more breastmilk 41
eat according to your energy needs.
you will produce.
 Breastfeeding
Getting started (continued)
• Drink plenty of fluids. A good habit is to have a drink What should I eat?
of water every time your baby feeds. Pregnancy and breastfeeding are some of the most
• Avoid cigarettes, alcohol and other drugs, coffee nutritionally demanding times for your body, so it’s really
and cola. If you find this difficult, talk to your health important to eat healthy foods to make sure both you and
professional for support and advice about how to your baby are as healthy as possible. This will make it
minimise the effects these products can have on your easier to cope with looking after your baby. Eat a variety
baby. These products contain ingredients that pass on of foods from each of these groups every day:
to your baby through your breastmilk. If you decide to • grain (cereal) foods, mostly wholegrain and/or high
continue to have these products, have them after a cereal fibre varieties
breastfeed rather than before.
• vegetables and legumes/beans
• If you need to take medication, ask your doctor to
• fruit
prescribe medication that is safe while breastfeeding.
• Get everything ready — e.g. drinks and pillows — before • lean meats and poultry, fish eggs, tofu, nuts and seeds
you start the feed or at the end of the last feed. and legumes/beans
• Your baby may need to feed very frequently in the first • milk, yoghurt, cheese and/or alternatives, mostly
weeks of life. As they grow, they will go for longer reduced fat.
between feeds (but feeding frequency may increase An iodine supplement of 150 micrograms each day is
during different developmental stages, and sometimes recommended in pregnancy and during breastfeeding.
towards the end of the day). Be assured that Iodine supports normal development of the brain and
breastfeeding during the night is both necessary and nervous system before birth, in babies and young
normal for babies. children. If you have a pre-existing thyroid condition
• Get to know your baby by cuddling and observing their check with your Medical Practitioner first.
cues. Be guided by your baby’s feeding cues, not the If you are following a special diet or a vegetarian diet, you
clock or others feeding schedules. may need extra advice from a dietitian/nutritionist.
• If you plan to return to work, talk to your employer
42 Breastfeeding mothers need to drink plenty of fluids,
about working and breastfeeding.
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 Talk to your local child health nurse, a lactation
let down. consultant, an Australian Breastfeeding Association
• Do what you can to relax — breathe deeply, lower your counsellor or your general practitioner.
shoulders, get someone to give you a back rub and try Telephone
to enjoy this special time with your baby.
• Your local child health nurse (see Queensland Health
• Have a warm shower or put a clean warm washer on Community Child Health Service in the White Pages).
your breast.
• 13 HEALTH (including 24-hour child health information
• Gently massage your breast towards the nipple. and advice) 13 43 25 84.*
• Express a small amount of breastmilk just before a • Australian Breastfeeding Association 24-hour/7-day
feed. free Breastfeeding helpline. Call from anywhere in the
Breastfeeding is a learned skill that doesn’t always come state on 1800 686 268.
easily. Many women experience some difficulties, • The Queensland branch of the Australian Breastfeeding
particularly in the early days. If you have any concerns, Association can be contacted by calling (07) 3254 2233
are experiencing any difficulties or need reassurance, or emailing [email protected].
contact a health professional. Addressing issues early will
make breastfeeding a more enjoyable experience for you Websites
and help you to keep breastfeeding for longer. • Queensland Health Breastfeeding
www.health.qld.gov.au/breastfeeding
For more information or assistance
• Australian Breastfeeding Association
In hospital www.breastfeeding.asn.au
Talk to a midwife or lactation consultant about any • Lactation Consultants of Australia and New Zealand
concerns you have. 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 43
unable to connect to 13 HEALTH then please contact your service provider
to discuss the issue.
 Breastfeeding
How do I start a breastfeed?
• Relax and make yourself comfortable. How will I know my baby is correctly attached
• Allow for skin to skin contact prior to a breastfeed. to my breast?
• Hold your baby close with their chest against yours. Correct breast attachment and positioning of your baby
are vital to avoid problems.
• Hold the baby behind the shoulders and back, allowing
the baby’s head to tilt backwards, ensuring a wide • If the cheeks are being sucked in or you can hear
mouth and deeper latch. a ‘clicking’, your baby is not attached properly.
• When attaching your baby, always bring your baby • If it hurts when your baby sucks or you suspect poor
towards the breast — not breast to your baby. attachment, put your finger in his or her mouth to break
the suction and try reattaching again. Just pulling your
• Your baby’s top lip should be level with your nipple.
baby off before suction is broken will hurt.
You can encourage your baby to open his or her mouth
wide by teasing the baby’s mouth with your nipple. • Breastfeeding should not be painful. Some women
Squeezing a little milk from the breast will encourage experience nipple sensitivity and tenderness in the
this even more. When your baby opens wide, bring first few days.
him or her quickly to the breast. The baby's chin should • Listen and observe your baby during a feed. Your baby
be tucked well into the breast, and the mouth should should look comfortable, relaxed and not tense or
be wide open with the bottom lip curled back. frowning.
• Make sure your nipple and a large amount of the areola • After feeding, your nipples will appear slightly longer
(the darker area around the nipple) are inside your but should not look squashed, flattened, white or
baby’s mouth. ridged.
• Remember to cradle your arm around your baby once
he or she is comfortably attached. Remember, attachment gets easier with 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 • Make sure baby's nose is not obstructed by the breast.
Good and poor attachment Remember
Painful feeding is a sign that something may be wrong.
Good attachment Poor attachment
inside appearance inside appearance 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 Poor attachment

outside appearance 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? • Let your baby finish the first breast before offering
• Babies need to feed often. They can have around the second breast. At the next feed, reverse the order.
8–12 feeds in 24 hours. Mothers and babies vary a lot. • It is fine to give your baby an extra feed to settle them.
How often you feed and how long it takes your baby to • Let your baby feed as long as he or she wants to.
feed differs from one mother to the next. With patience, Some babies will have a rest at the breast and then
you and your baby will develop your own pattern which start sucking again, so let your baby decide when to
will adapt as your baby grows. Demand feeding allows come off. As a guide, try to keep your baby’s feeds no
your baby to let you know what he or she needs. 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. If your baby feeds for longer than one hour on a regular
As babies get older and are able to suck more basis, it may indicate a feeding problem (e.g. incorrect
efficiently, they often have shorter feeds and may sleep attachment). Access your local Community Child Health
longer between feeds. 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
Breastfeeding
Is my baby getting enough milk?
How do I know my baby is getting enough milk? • Your baby should be mostly contented after feeding.
• Breastfed babies usually demand feed 8–12 times in a Most babies will have an unsettled period somewhere
24-hour period. in the day. This should not be misinterpreted as running
out of milk at the end of the day.
• Watch for frequent swallowing. Swallowing after 1–3
sucks is normal. • Your baby’s weight gain should be going well. Babies
lose weight shortly after they are born. They start to
• After your milk comes in (4–6 days) baby should have
regain this weight by day 4–6 and should have
at least 6–8 wet cloth nappies or 5–7 wet disposable
regained their birth weight by 2 weeks. After this, check
nappies in 24 hours. Their wee should be pale in colour.
your baby’s growth regularly and make sure it is
• Breastfed babies are rarely constipated, so a dirty recorded on the growth chart in your baby’s Personal
nappy can occur after each feed. Typical breastfed Health Record book. The fact that your baby’s growth
babies’ bowel motions are loose and mustard yellow follows the general pattern or curve of the graph is the
but can sometimes be green or orange. If concerned, most important thing. A baby who is gaining weight is
review with a trained health professional. None of getting enough breastmilk. A judgement on your baby’s
these changes are a problem in a healthy breastfed growth is best made only after a series of
baby. They will be different to the bowel motions of measurements. A one-off unusual measurement is not
formula fed babies. usually cause for concern if your baby is contented and
• The number of bowel motions of breastfed infants healthy. Check the accuracy of measurements, use the
tends to decrease between 6 weeks and 3 months of same baby scales all the time and always weigh
age. Intervals of several days or more between stools without clothes and nappy (or always with a dry nappy).
are common. • Growth monitoring is best done by a health
• Frequent, runny stools do not mean a breastfed infant professional who can discuss your child’s development
has diarrhoea or lactose intolerance – they should with you. It is important to consider growth using both
simply be viewed as evidence of sufficient milk. If weight and length measurements in combination.
concerned, review with a trained health professional.
• Your baby should have bright eyes, a moist mouth and
47
good colour.
 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 Try these ideas to help to stimulate your sleepy baby
that affect the establishment of breastfeeding. and encourage them to feed:
• Allow skin to skin contact between you and your baby.
Sleepy baby • Change their nappy.
Some babies are affected by: • Express a little colostrum and give it by teaspoon,
• long labours or surgical intervention, causing syringe or cup to give your baby the ‘taste’ so they
sleepiness in some babies will start seeking your breast.
• anaesthetics and other drugs given during labour, • Unwrap your baby, talk to them and gently stroke
so they may be sleepy for long periods. their legs and tummy.
The first 72 hours are very important in the stimulation • Stroke their lip and cheek.
of breastmilk. If a baby is fed well at least once in the first • Cuddle your baby against your breast.
day since birth there is no cause for concern. During the
• If your baby is too sleepy to accept your breast when
day time if your baby does not ‘ask’ for a feed after about
offered, you will need to express your colostrum and
5 hours, they can be woken and put to the breast. It is
offer this to your baby. If your baby continues to be
recommended that your baby has a minimum of 6 (but
sleepy and you are concerned, seek advice from
preferably at least 8–10) breastfeeds in 24 hours. It will
your GP or breastfeeding trained health professional.
be easier to demand feed if your baby is in the same room
as you in hospital. • 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 Regurgitation is common and may occur in about
Babies cry for many reasons. It is your baby’s main form of 40 per cent of babies under 3 months. Most babies with
communication. Babies cry with their whole bodies regurgitation or reflux are healthy and grow well. By 6–10
including their legs, so the normal leg action of a baby is months, as your baby spends more time during the day
often misinterpreted as wind. in an upright position, the regurgitation usually settles.
Breastfeeding is not the cause and does not make
It is normal for babies to have at least one unsettled
regurgitation any worse.
period per day. It usually occurs in the evening but can
happen at any time. During these times your baby may Breastfeeding does not cause colic or reflux.
want to feed frequently and often seems to be snacking.
This often causes mothers to be worried about their milk
Tip
supply but that is rarely the cause of the problem. These • The process of winding wakens a baby into action for
frequent feeds ‘put in the order’ for the next day and the rest of the feed, but you do not have to wait for a
should be welcomed as they will ensure your continued ‘burp’ before continuing the feed or settling your baby
milk supply. Do not offer formula as it will upset this to sleep.
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
Common breastfeeding concerns
Common early problems — tender or cracked nipples
Tender nipples Cracked nipples
Some nipple tenderness is normal at the start of feeds Tips
in the first 1–2 weeks. After these early days, incorrect • Seek assistance from your child health nurse,
attachment is the most common cause of nipple pain. an Australian Breastfeeding Association counsellor
Tips or other breastfeeding trained health professional.
• Wash hands well before handling breasts. • Poor attachment is the most common cause of cracked
nipples.
• If you are using breast pads, change them when
they are wet. • Follow suggestions on this page for tender nipples.
• Avoid using shampoos and soaps on nipples. • If it is too painful to breastfeed, avoid feeding on the
sore breast (for 12–24 hours) but express milk during
• When you need to take your baby off your breast,
this period.
do it carefully by breaking the suction with your little
finger in the corner of your baby’s mouth. • Express milk by hand and feed the milk to your baby
in a bottle or cup.
• Expose your nipples to the air after each feed.
• Gently remove breast pads to stop further damage
• Allow breastmilk to dry on your nipples after each feed
to your nipples. If the pad sticks to the breast, express
as it has properties that protect against infection.
a little breastmilk to moisten it before trying to remove
• Generally avoid applying ointments, sprays, tinctures it again.
and powders.
• 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 A blocked milk duct presents as a painful, swollen firm
can also happen when there has been a long separation mass in the breast and the skin over that area may be red.
from the mother or when breastfeeding has been stopped If left untreated can lead to mastitis.
too suddenly. Some mothers get concerned that they have
too much milk. This is only a temporary problem and will Tips
sort itself out as your body gets used to breastfeeding. • Feed your baby as often as possible, starting with the
affected breast.
Tips • Gently massage the lump towards the nipple while
• Wear a comfortable, supporting bra that is not too tight. your baby is feeding to help clear the blockage.
• Take your bra off to feed when able and let the milk flow • Start each feed on the affected side for 2–3 consecutive
freely from your second breast onto a towel. feeds to help the breast drain. Then offer the second
• Massage your breasts gently during feeds. breast or express for comfort.
• If your baby is having difficulty attaching, gently • To improve drainage of the affected area, it is best to
express a small amount of milk to soften the areola (the have your baby’s chin pointing towards the blocked duct.
darker area around the nipple) before a feed. • If your baby’s feeding has not reduced the lump, gently
• Demand feed your baby to keep your breasts massage toward the nipple while hand expressing.
comfortable (8–10 feeds or more in 24 hours). • Apply warmth before and during a feed and cold
• If your breasts become painful, seek assistance afterwards to the area. (A warm shower or a cool
from a breastfeeding trained health professional. compress can relieve pain or discomfort.)
Weaning is also a common time for swollen breasts and • Check your bra is not too tight and remove during feeds
mastitis. If your breasts become engorged when cutting if you prefer.
down the number of feeds, you may need to express a • Sleep without a bra as much as possible.
little for comfort to prevent the risk of mastitis. Too much • Positioning and attachment should be checked.
expressing may stimulate further milk production.
52 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 • Emptying of the affected breast by breastfeeding or
occurs in one breast but may spread to the other. expressing is very important until infection has gone,
Symptoms of mastitis include: to reduce the chance of complications.
• inflammation of the breast • 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 Expressing breastmilk
or away from your baby: • Wash your hands with soap and warm water. Dry hands
• Talk to your employer as early as possible, even with a clean towel, single-use towel or air dryer.
when you are still pregnant.
• Find somewhere private where you can sit down, relax
• Take as much time off work as you can. and not be interrupted.
• Work from home.
• Have all expressing equipment ready, clean and
• Work part-time. sterilised.
• Have someone bring your baby to you when she • Encourage the milk flow by gently massaging the breast
or he needs a breastfeed. – start from the top of the breast and stroke towards the
• Use a child carer close to where you work so you can nipple, massage the underside too and repeat several
go to your baby to feed. times to ensure that the whole breast is massaged.
• Express breastmilk while you are away and replace
the missed breastfeeds with expressed milk fed from
Hand expressing
a cup or a bottle. • Place thumb and fingers on opposite sides of your
breast just behind the areola (the darker skin around
• For babies over 6 months, continue breastfeeding and
your nipple).
replace missed breastfeeds with appropriate solid
food. Offer expressed breastmilk or water. • Rhythmically squeeze your breast with a rolling
movement between the thumb and fingers. Try about
• Replace breastfeeds while you are away from your baby
twice per second. Be gentle especially if your breast
with infant formula and then continue to breastfeed in
is very full.
the hours and days when you are not at work.
• Drops of milk form on the nipple. Milk flow may soon
• Use night feeds to meet your baby’s need for comfort
start and milk may spray. When the flow stops, move
and closeness.
your thumb and fingers around the areola so that all
the milk ducts are stimulated and drained.
54 • 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
• Ask whoever you got it from to show you how it works. water for a few minutes (no more than 10 minutes).
• It is often faster than hand expressing (should only take • Before feeding your baby, check the temperature of the
around 10 mins) but you will not necessarily get more milk. milk by letting a little drop onto the inside of your wrist.
It should feel comfortably warm or even a little bit cool.
• Massage the breast towards the nipple while you are
(This is safe on unbroken skin.)
using the pump. This helps to get the breastmilk out.
Use a warm washer to assist breastmilk to flow. • Never microwave breastmilk.
• Discard any warmed milk that has not been used.
Storing expressed breastmilk
Transportation of breastmilk
Pour the collected milk into a sterilised container and put
it in the refrigerator or into the freezer, making sure to • Use an insulated container (such as an esky) with
label with the date and time before freezing. a freezer brick.
• If frozen milk remains frozen on arrival, put it directly
Breastmilk can be:
into the freezer.
• refrigerated for up to 3 days (4°C or lower)
• If some of the milk has thawed put it in the refrigerator
• stored without refrigeration (if needed) for 6–8 hours
and use it within 4 hours. Do not refreeze it.
if the temperature is less than 26°C
• If the milk has never been frozen you can either store
• frozen in the freezer section of a refrigerator with
it in the refrigerator or freeze it.
a separate freezer door (-18°C) for up to 3 months
• 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 Distractions
needs for around the first 6 months of life. After this time As your baby gets older and more interested in and aware
babies need solid food in addition to breastmilk. of the surrounding world, he or she may frequently come
Queensland Health, the National Health and Medical off during a feed to have a look around. You may need to
Research Council and the World Health Organisation all feed in a quiet room with fewer distractions.
recommend that you continue breastfeeding until your
baby is at least 12 months old and for as long after that Breast refusal
suits both you and your baby. Babies can sometimes refuse the breast. This can be
As your baby gets older, you may experience the following one-off or repeated and is most often temporary. Causes
concerns. Here are some tips to help you to keep can be baby related (e.g. a cold, distractions, teething)
breastfeeding. or mother related (e.g. hormonal changes, medications,
change in perfume). Try to find and deal with the
Low supply underlying problem. If refusal continues, contact your
The more you feed, the more milk you will make. Offer the child health nurse, an Australian Breastfeeding
breast between the usual feeds; offer the breast as a Association counsellor, lactation consultant or other
comforter instead of a pacifier. Always feed from each breastfeeding trained professional.
breast more than once each feed. Express milk between
feeds.
Return of menstrual cycle
You may notice that your baby is a bit fussier with feeding,
Teeth however this will pass after the first few days of your
Teeth may initially make the feed feel different but should cycle.
not cause any discomfort. Biting may occur at this stage
when your baby is getting used to and testing out her or
Support and assistance
his new teeth. When this occurs, temporarily remove your If you need assistance or support with any of these
baby from the breast and return them when they are ready concerns, refer to the sources listed on page 43.
to feed. Your baby will soon learn not to bite at feeding
time.
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 Maintain breastfeeding
blood into the breastmilk, usually in very small amounts. Breastfeeding is the normal way to feed babies and has
The extent to which this happens depends on a number of many advantages for both you and your baby.
factors, including the nature of the drug concerned, the
Its benefits are so important that breastfeeding should
fat content of the breastmilk and the drug level in the
only be discontinued if there is strong evidence that
mother’s body.
a drug taken by the mother will harm the infant and there
Breastfeeding mothers can safely use most prescribed is no alternative treatment.
medications. If you do need to take medications, always
check with your pharmacist or doctor before taking the Choose the right medication
drug. This includes prescription and non-prescription If you need to take medications while breastfeeding,
items as well as vitamins, minerals, and herbal discuss with your doctor about the safest option for you
preparations. and your baby. If required, your doctor will discuss the
Recreational drugs are excreted into breast milk and may risks and benefits of using the medication while
be passed on to the baby. Contact your nearest Alcohol breastfeeding and have your therapy individualised.
and Drug Services for more information. Talk to a pharmacist for advice on the best time to take
Use this booklet as ready reference to work out which your medications to minimise drug expose to your child.
common drugs are safe to take. For further information
about the use of medicines/drugs in breastfeeding Exposure in the womb
contact the NPS Medicines Line: 1300633424 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 Cold, flu and asthma drugs
fever Breastfeeding mothers should try to avoid cold and flu
Paracetamol, when taken as directed is quite safe to take tablets containing pseudoephedrine and phenylephrine,
while breastfeeding. Common brand names for such as Sudafed® and Demazin®. That’s because these
paracetamol include Pandol, Dymadon and Panamax. agents can sometimes cause breastfeeding babies to
Aspirin at doses used for pain relief should be avoided. become irritable and restless. Pseudoephedrine can
However, a once off single dose may be taken. also cause a significant reduction in milk volume.

Products containing codeine such as Panadeine, Try imidazole nasal spray decongestants instead,
Dymadon Co and Codalgin should only be used after like Sinex® and Otrivin®. Your pharmacist will be able
consultation with your doctor. to identify these for you.

For period or muscular pain, you can take the above Lozenges and gargles are safe for sore throats, though
drugs. As well, anti-inflammatory drugs such as ibuprofen it is best to avoid gargles containing povidone-iodine,
(Nurofen®, Actiprofen®) and diclofenac (Voltaren®) are such as found in Betadine® and Viodine®.
very effective, but should be taken in low doses for short Most cough mixtures are safe, but avoid products
periods of time only. containing pseudoephedrine and phenylephrine.
Creams and sprays available for muscle aches and pains Asthma treatment (e.g. puffers), should be the same
are safe to use. for breastfeeding women as for those who are not
Mefenamic acid (found in Ponstan®) and indomethacin breastfeeding, and is quite safe.
(e.g. Indocid®) are best avoided by breastfeeding
mothers. Other anti-inflammatory drugs such as
ibuprofen or diclofenac are preferred.

60
Hayfever and allergies Contraception
There are some antihistamines on the market such as If you want to take the contraceptive pill while
loratadine (Claratyne®), fexofenadine (Telfast®) and breastfeeding, you should only be prescribed the
cetirizine (Zyrtec®) that do not cause sleepiness. Of these, mini-pill. Common brand names include Microlut®,
loratadine (Claratyne®) is the safest for you to use. Noriday®, Locilan®and Micronor®.
Older antihistamines such as dexchlorpheniramine Combined oral contraceptive pills – like Nordette®,
(Polaramine®), promethazine (Phenergan®) and Microgynon®, Triphasil®, Triquilar ® and many others –
pheniramine (Avil®) may cause drowsiness as a side should not be taken.
effect and are better avoided. Use with caution while The morning-after pill (Postinor ®) is quite safe for
breastfeeding and observe your baby for side effects emergency contraception.
such as excessive sleepiness. Avoid sustained release
preparations (such as Polaramine Repetabs®). Depo-Provera® and Depo-Ralovera® (both three-monthly
injectable contraceptives) are excreted into breastmilk in
Nasal sprays such as budesonide (Rhinocort®) and very low amounts, and are also safe for use. They should
beclomethasone (Aldecin® and Beconase®) are quite be given about 6 weeks after the birth.
safe.
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 At all times, do not use more than the recommended
If breastfeeding, the safest laxatives to use are fibre- standard dose of herbal products, and use single
based products, such as Metamucil® and Fybogel®, ingredient products rather than combination products of
followed by docusate (Coloxyl®). unknown herbs.
Large doses of senna (as found in Senokot®, Coloxyl® Alcohol
with Senna®, and Nulax®) or bisacodyl (Durolax®)
The national alcohol guidelines recommend that if you are
can cause diarrhoea in your baby.
breastfeeding, the safest option is not to drink alcohol.
Vitamins, minerals and herbal preparations When you drink alcohol it enters your breast milk and
within 30-60 minutes your breastmilk has the same blood
Many vitamin and mineral supplements are safe to use
alcohol level as you do.
during the breastfeeding period.
During the first years of life, your baby’s brain is still
In fact, B-group vitamins in normal recommended
developing at a very rapid rate and drinking alcohol while
dosages may be particularly beneficial to mothers lacking
breastfeeding can affect your baby’s brain development.
energy.
If you are breastfeeding and you choose to drink alcohol, try
Be aware, though, that natural drugs like herbal
to avoid alcohol in the first month after your baby is born
preparations may be natural but they may not necessarily
until breastfeeding is well-established. After that:
be harmless. Many herbal drugs contain chemical
substances that may be dangerous to the infant and • alcohol intake should be limited to no more than two
numerous poisonings have been reported in the past. standard drinks a day
So, if you are breastfeeding and want to take a herbal • you should not drink alcohol immediately before you
supplement, check with your pharmacist, doctor or breastfeed. There should be 2-3 hours between the
child health nurse about its safety first. alcohol consumption and breastfeeding
• you should consider expressing milk in advance if you
For example, high doses of garlic can really irritate
want to drink alcohol.
breastfed babies, so it’s best to avoid garlic as
62 a supplement.
Smoking Illicit drugs
If you’re breastfeeding, you should try to stop or decrease Illicit drugs include illegal drugs — like marijuana, heroin
your smoking as much as possible. 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. You should avoid the use of illicit drugs or prescription
Quitting smoking is the best thing you can do for you and drugs prescribed for another person if you are
your baby’s health. You can call Quitline 13 QUIT (13 breastfeeding.
7848) seven days a week for free information, practical Recreational drugs are excreted into breast milk in varying
assistance and support. amounts, and are passed on to the baby.
If you are finding it difficult to quit, intermittent forms of Prolonged exposure to these drugs can also result in both
Nicotine Replacement Therapy like gum or lozenges are the mother and the baby becoming dependent on the
safer than continuing to smoke. The Quitline can also drugs.
assist with this.
If you are using illicit drugs, you should disclose this to
Mothers who use nicotine gum should try to use gum your health care professional so that they can assess
immediately after breastfeeding to allow nicotine levels to whether it is safe to breastfeed your baby.
reduce before baby’s next feed.
ADIS (Alcohol and Drug Information Services) is a
If giving up smoking is not possible, you should reduce confidential 24/7 telephone counselling, information and
smoking as much as possible, completely avoiding referral service for those struggling with alcohol and drug
smoking in the hour before feeding and during feeding. use. 1800 177 833
No-one should smoke inside your house or your car or
outside near windows and doors as smoking is a known
For more information
risk factor for Sudden Infant Death Syndrome (SIDS). Keep this booklet as a handy reference.
* If you are having difficulty connecting it may be useful to dial If you want more details, talk to your pharmacist, doctor
13HEALTH using only the first six digits of the phone number or child health nurse, or call the Medication Helpline on
(13 43 25). If you are still unable to connect to 13HEALTH then 1300 888 763 or 13 HEALTH (13 43 25 84*). 63
please contact your service provider to discuss the issue.
 Formula feeding
Bottle feeding
If breastfeeding is not possible, the use of a commercial Getting started
infant formula is recommended. Cows milk-based formula
is suitable for most babies and is recommended over Check the instructions on the formula container and
formulas made from soy or goats milk. These and other always use the scoop provided with the formula being
specialised formulas should only be used under the used. Formula that is too strong will hurt your baby’s
advice of a health professional. Regular unmodified cows kidneys; too weak and your baby won’t grow well.
or goats milk is not suitable for babies and should never 1. Clean surfaces where formula will be made with a
be given as a drink in the first 12 months. clean cloth.
If your baby is formula fed, seek advice on formula from 2. Wash your hands using soap and water and dry well.
your doctor, child health nurse or dietitian. In Australia, a 3. Clean and sterilise the bottle, teat and other feeding
range of suitable infant formulas is available. It is equipment before you start (see page 66 on cleaning
preferable to use an infant formula with a lower protein infant feeing equipment)
level. The use of ‘follow-on formula’ for infants aged 6–12 4. Boil fresh water and allow it to cool until luke warm
months is not considered necessary and no evidence has – to cool to a safe temperature, allow the water to sit
shown advantages over using ‘infant formula’ It is for at least 30 minutes.
recommended to keep your baby on infant formula until
5. Pour the required amount of cooled, boiled water into
12 months of age. After around 12 months you can
the sterilised bottle.
introduce pasteurised full cream milk.’
6. Add the required number of scoops of formula to the
Holding your baby close during feeding builds a close, water. The scoop should be lightly tapped to remove
loving bond between you. Your baby can feel, smell and any air bubbles, then use a sterilised knife to level off
see you, and this is when strong bonding between the each scoop. Keep the scoop in the can when not in
baby and the carer can develop. 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.
64
8. Before feeding your baby, check the temperature of Preparing feeds in advance
the feed by letting a little milk drop onto the side of
your wrist. It should feel just warm, but cool is better Ideally, prepare only one bottle of formula at a time,
than too hot. just before feeding. If formula needs to be prepared in
9. Discard any formula that has been offered to your advance it must be refrigerated (at 5°C or below) and used
baby and not been consumed within 1 hour. Do not within 24 hours. Alternatively, prepared sterilised bottles
reheat half-empty bottles. of boiled water may be refrigerated and used as required,
first warming by standing bottle in a container of warm
10. Hold your baby close and talk to your baby (if it is not
water and then adding formula.
too distracting) while feeding and respond to your
baby’s cues – parent–infant contact is extremely Warming formula
important
It is safe to give cool formula to babies; however most
Do not leave your baby alone to drink the bottle. Do not babies seem to prefer to have it warmed.
put your baby to sleep while drinking from a bottle – as
• Refrigerated prepared formula should be warmed by
well as the risk of choking, this increases the risk of infant
standing the bottle in a container of warm water before
tooth decay, ear infections and associated hearing loss.
feeding the infant.
Teats • Do not use a microwave to heat infant formula, as
Teats are available in a range of shapes and materials. heating can occur unevenly and burn the infant’s
There is no evidence to support the benefits of particular mouth.
teats for problems such as colic (unsettled infants). • Formula should not be removed from the refrigerator
Several types of teats may have to be tried until a suitable and warmed until immediately before feeding.
one is found.
• Discard any formula left at the end of the feed. Any
All teats should be cleaned well with a bottle/teat brush formula that has been at room temperature for longer
and sterilised correctly. Teats need to be checked and than 1 hour should be discarded.
replaced regularly.
65
 Formula feeding
Bottle feeding (continued)
Transportation of formula Boiling method
• The safest way to transport formula feeds is to carry 1. Wash your hands using soap and water.
individual portions of the powdered formula and the 2. Wash teats and bottles in hot, soapy water using a
cooled boiled water in separate sterile containers, bottle brush and rinse well.
and make up the formula when required. 3. Place equipment (including bottles, teats and caps) in
• Alternatively, the formula can be made up and a large saucepan on the back burner of the stove.
refrigerated (temperature no higher than 5°C) until 4. Cover utensils with water, making sure to eliminate all
they are cold before transporting. air bubbles from the bottle.
• Do not remove the feed from the refrigerator until 5. Bring to the boil and boil for 5 minutes. Turn off – do
immediately before transporting. not allow it to boil dry.
• Transport feeds in an insulated bag with ice bricks 6. Allow the equipment to cool in the saucepan until it is
and use within 2 hours. If you reach the destination hand hot and then remove it – be very careful if
within 2 hours, place the feeds in the refrigerator at children are present.
the destination and use within 24 hours of the time 7. Store dry sterilised equipment that is not being used
of preparation. straight away in a clean covered container.
Cleaning infant feeding equipment 8. Sterilised equipment can be stored in the refrigerator
for up to 24 hours.
(bottles and teats)
Cold sterilisation
Feeding equipment should be sterilised until the baby is
at least 12 months old. Thoroughly clean bottles and teats 1. Wash the bottles and teats with cold, soapy water.
manually or in a dishwasher. Bottles and teats can be Rinse with cold water.
sterilised using boiling or steaming methods or cold 2. Make up the sterilisation solution following the
sterilisation. Use commercial steamers according to the manufacturer’s instructions carefully when making up
manufacturers’ instructions. Chemical sterilisers can be the solution to ensure the correct dilution.
used with cold water. It is a good idea to keep some 3. Make sure all equipment is made of plastic or glass:
66 sterilising liquid or tablets on hand for emergencies. metal corrodes when left in chemical sterilant.
4. Completely submerge everything, making sure there It is important to be aware that there are many individual
are no air bubbles, and leave it in the solution for at variations in the amount of formula and the number of
least the recommended time – equipment can be left bottles consumed every 24 hours. Information on formula
in the solution until it is needed. packages recommending certain amounts for various
5. Use tongs to remove items from solution and shake ages is a guide only and does not necessarily suit every
off excess liquid when you are ready to use a bottle infant. Plenty of wet nappies (six or more per day),
and teat. Use the bottle and teat immediately, do not consistent (but not excessive) weight gain, and a thriving,
rinse solution off. active infant indicate that all is well.
6. Discard the solution after 24 hours, thoroughly scrub
How to feed
the container and equipment in warm water with
detergent and make up a new solution. Seat yourself comfortably and hold your baby in your arms
7. Store the sterilising concentrate and solution well out while giving the bottle. Hold the bottle tilted, with the
of the reach of children. neck and teat filled with formula. If your baby does not
firmly grip the teat, gently press under their chin with your
How much formula? middle finger and slightly withdraw the teat to encourage
Bottle fed babies should be fed on demand. Each baby sucking. This method will help to prevent your baby from
is different and needs vary from day to day. Refer to the swallowing air, which can cause wind pain.
‘Is my baby getting enough milk?’ section on page 47 if Check the bottle flow. When the bottle is upside down,
you are concerned about how much your baby is drinking. the milk should drop at a steady flow from the teat.
The following can be used as a general guide: Sometimes the teat gets clogged when a powdered
formula is used. Check teats often.
• 1 to 4 days: Commence at 30–60 ml/kg bodyweight/
day and increase over the next few days Even when fed properly, a baby swallows some air. Hold
• 5 days–3 months: 150ml/kg bodyweight/day your baby upright over your shoulder or upright on your
lap with your hand supporting under their chin. Pat or rub
• 3–6 months: 120ml/kg bodyweight/day
the middle of their back gently until they burp. If the baby
• 6–12 months: 100ml/kg bodyweight/day . is feeding happily, don’t stop until they are ready! Watch 67
for signs that your baby has had enough.
 Introducing solid foods
When and why Food allergies
At around 6 months, your baby needs to start eating foods What is an allergy?
other than breastmilk or infant formula. Baby's first foods An allergy is an adverse reaction by the body to a foreign
and other drinks are commonly referred to as 'solids'. It material. Antibodies are produced and these cause the
may be the right time for your baby to start eating solids allergic reaction.
when:
There appears to be increased allergy risk with starting
• your baby can hold his or her head steady and can
solids early (less than 4 months) and late (after 7
sit on your lap with support
months).
• your baby has progressed from sucking to biting
• your baby opens his or her mouth when you put Symptoms of allergies
a spoon near it • Skin rash and swelling
• your baby can move smooth food from the front
• Abdominal pain and diarrhoea
of their tongue to the back, and swallow
• Vomiting
• your baby’s appetite and nutritional requirements are no
longer satisfied by breast milk or infant formula alone • Eczema
• your baby is starting to get interested in the world • Difficulty breathing or swelling of tongue*
around them, especially the food you are eating. • Becoming pale and floppy*
For good health, your baby needs to start eating solids at *
Serious reactions – call ambulance immediately.
around 6 months because his or her stores of iron and zinc
Reactions can occur immediately (within seconds to
begin to fall and energy needs are starting to increase.
2 hours of eating) or may be delayed (may take hours
Introducing solids too early may make your baby sick, as
or days after eating).
their digestive system has not developed enough.
Delaying introduction of solids beyond 6 months may
Note: Food intolerance (an adverse reaction to food which
cause nutrient deficiencies, increase the risk of food
doesn’t result in the production of antibodies) and food
allergy, and may result in food refusal or fussy eating.
aversion (an avoidance of foods which may be based
This is another opportunity to emotionally connect with on individual sensitivities) are not the same as allergy.
68 your child, so it is important to try to make it a positive
experience for everyone.
Allergies can be caused by factors other It is important to get specialist help
than food You don’t want to unnecessarily restrict a child’s diet,
• It is difficult to identify problem foods when there are especially during periods of vital growth and
other factors that could be causing the responses. development.
Allergies and intolerances are more common in young
Sensible precautions
children as their immune system is not yet fully
developed. Most will grow out of these responses. There is insufficient evidence to support previous advice
• If food is found to be the problem, a decision must be to specifically delay or avoid potentially allergenic foods
made as to whether dietary restriction is needed. (such as egg, peanut, nuts, wheat, cows milk and fish)
for the prevention of food allergy or eczema. This applies
• Restricting dietary intake places the entire family under
to infants with siblings who already have allergies to
great strain — nutritional, social and psychological
these foods.
— and other treatments may be more realistic.
If you have concerns, you should seek advice from your
• Parents need to be realistic and seek advice before
health professional.
changing their child’s diet.
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 • Respond to signs that baby is full – turning head,
• Choose a time when your baby is happy, you are calm refusing to open mouth. Never force baby to eat or
and have time to focus on your baby. finish all the food in their bowl.
• Solid foods should supplement breastfeeding or • Don’t put the spoon or food in your mouth before giving
formula but not replace it. Continue to breastfeed or it to your baby. Transferring bacteria from your mouth
formula feed as you were doing before you introduced can cause tooth decay.
solids. • Cows milk should not be introduced as a drink until
• Start with iron fortified infant cereal and/or iron rich 12 months of age but can be added to food.
foods such as pureed meat or tofu, followed by other • Honey can cause infant botulism, a rare but serious
foods from the Five Food Groups (see www.eatforhealth. illness that can cause paralysis. It is not an essential
gov.au/food-essentials/five-food-groups). Introduce food and should not be introduced before 12 months.
different tastes and textures as your baby grows. Do not use honey as a sweetener on dummies or
• Make the food smooth and mushy by adding breastmilk bottles.
or formula. This may mean pureeing food with a blender
or pushing it through a sieve.
Breastmilk and formula feeds
Continue to breastfeed on demand or, if formula feeding,
• Do not add sugar, honey or salt. Babies have very
aim for around 100ml/kg a day. Breastmilk or infant
sensitive taste buds and added salt can be bad for
formula is still your baby’s main food at this age.
their kidneys, whilst sugar can cause tooth decay.
• Offer 1–2 teaspoons after a breast or formula feed. Tips
Slowly increase this to around 2 tablespoons. • Clean your baby’s teeth as soon as they appear to
• Start with offering solids once a day and gradually build prevent tooth decay. Start by using a small, soft
up to 3 times a day. toothbrush moistened with water. At 18 months, brush
• Expect that your baby may refuse some new foods. This with a small (pea-sized) amount of low fluoride
is normal and it might take up to 30 times before your toothpaste.
70 baby learns to like some foods. Continue offering it at
other times and on other days.
• Make sure the food you feed your baby is stored correctly Sample menu 6–7 months
and prepared in a clean environment. Babies are very
Breakfast
sensitive to food poisoning. Keep prepared food in your
fridge for 1–2 days only. Prepared foods should not be Baby cereal (1 tablespoon) mixed with breastmilk or
reheated more than once, and any foods served but not formula
eaten by your baby should be thrown away. Mashed fruit (½ tablespoon)
Yoghurt (½ tablespoon)
• Expect changes in your baby’s nappies as new foods
Breastmilk / 100 ml infant formula
are introduced.
• Drinking plain water is a good habit to start early. Mid-morning
Start to introduce cooled boiled water from a cup with Breastmilk / 150 ml infant formula
a spout. Soft drinks, cordials and tea are not suitable
drinks for babies. Fruit juice is also unnecessary. Lunch
• For convenience, prepare food ahead of time and freeze Blended/mashed meat (1 tablespoon)
it in ice cube trays or small individual containers for Blended/mashed vegetables (1 tablespoon)
later use. Bread cut into pieces (½ slice) or pasta/rice (1
tablespoon)
This is a really exciting time. It is not just about nutrition,
Breastmilk / 100 ml infant formula
it's also about exposing your baby to a variety of healthy
foods to improve their acceptance of new flavours, and Mid-afternoon
sharing the enjoyment and social aspects of eating. Breastmilk / 150 ml infant formula
Check your baby’s growth regularly and make sure it is
recorded on the growth chart in your baby’s Personal
Dinner
Health Record book. Continue to check that your baby’s Blended/mashed meat (1 tablespoon)
growth follows the pattern or curve of the graph. If the line Blended/mashed vegetables (1 tablespoon)
of growth curve is flat or moving downward at all or Pasta or rice (1 tablespoon)
upward crossing a number of percentiles, speak with a Breastmilk / 100 ml infant formula
health professional. 71
 Introducing solid foods
Feeding from 7 to 12 months
By now your baby is eating pureed meats, baby rice • Accept mess! This is an important time for your baby to
cereal, pureed fruit and pureed vegetables, as well as experiment with food — let them touch it and self feed.
breastmilk or formula. • Introducing a variety of foods at this age will make
refusal of new foods and feeding problems less likely
Breastmilk and formula feeds later on.
Continue to breastfeed or, if formula feeding, aim for • Keep trying a variety of new foods from the Five Food
around 100ml/kg a day. Only expressed breastmilk, Groups. (see www.eatforhealth.gov.au/food-essentials/
formula or water should be put in your baby’s bottle. five-food-groups)
Babies can also be fed by a feeding cup from around • Sugar or salt should not be added to food for babies.
6 months. It is recommended that breastfeeding be • Fish: Cook fresh boneless fish well and check thoroughly
continued to at least 12 months and beyond. If your baby by feeling all the fish with your fingers for bones. If using
is formula fed, 11–12 months is a good time to stop using canned fish, use unsalted water-packed fish.
bottles and use a cup, but infant formula should still be • Avoid high sugar, fat or salty foods such as lollies,
used until 12 months. sweet drinks, chips and savoury biscuits. These do not
help your baby grow well, and can lead to less room for
Foods to add in
acceptance of healthy foods.
• Once baby is managing to eat smooth food, vary the
• Cooled boiled water, expressed breastmilk or formula
texture of the foods from smooth, to fine mash, to
can be offered from a cup.
lumpy mash and minced food. Giving different textures
of food is good for jaw and speech development, and • Cows milk should not be introduced as a drink until 12
can reduce the risk of later feeding difficulties. months of age but can be added to food.
• Foods should be offered three times a day, at routine • Foods with a high risk of choking such as whole nuts,
meal times, moving from after to before breastfeeds or seeds, raw carrot, celery sticks and chunks of apple
infant formula at around 9 months as intake increases. should be avoided for the first 3 years as their size and/
or consistency increases the risk of inhalation and
• By 8 months your baby should also be able to eat a
choking. However, nut pastes and nut spreads can be
72 range of finger foods in addition to lumpy foods, which
offered to infants from around 6 months of age.
encourages self feeding.
Tips Planning meals from 7 to 12 months
• Serve freshly prepared food or food that has been kept How much food is eaten at this age varies from child to
in the refrigerator for no longer than 1–2 days. child and from day to day and is influenced by growth
and activity levels. These serving sizes and amounts
• Sit your baby with the family at meal times to watch and
can be used as a guide to feeding your 7–12 month old
learn. Give your baby a spoon to hold too, even if you
each day. Some serving sizes are different to those
are feeding them.
commonly used for adults. While it is recommended to
• The amount of food your baby needs will vary — provide introduce solid foods from around 6 months of age, it
healthy foods and allow your baby to decide how much may take around a month to reach these amounts.
they want to eat. Don’t expect them to always finish the
food on their plate. Use their growth and contentment By 12 months of age, infants should be consuming a
as a guide that they are getting enough. wide variety of nutritious foods enjoyed by the rest of
the family.
The quantities in the following sample menu are a guide
only. How much babies eat varies a lot from one baby to Grains (cereal) foods
the next. Appropriate weight gain and development will 1½ serves a day
guide whether your baby is getting enough. Your baby’s One serve = one slice of bread, or ½ medium roll or flat
appetite may vary during growth spurts and teething. bread or ½ cup cooked rice, pasta, noodles, porridge or
Respond to signs of fullness and never force your baby to polenta, barley, buckwheat, semolina, cornmeal,
eat — it is OK to have food left over on their plate. quinoa, bulgur, quinoa or 3 crisp breads, 1 English
Check your baby’s growth regularly and make sure it is muffin or scone or crumpet
recorded on the growth chart in your baby’s Personal
Health Record book. Continue to check that your baby’s
Infant cereal (dried)
growth follows the pattern or curve of the graph. If the line 1 serve a day
of growth curve is flat or moving downward at all or One serve = 20g
upward crossing a number of percentiles, speak with a
health professional.
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 Breakfast
One serve = 20g cooked vegetables or legumes, fresh
Baby cereal (approx 3 tablespoons) mixed with breastmilk
vegetables are best but frozen and canned are also good
or formula or full cream cows milk
alternatives.
Mashed fruit (1 tablespoon)
Fruit Full cream yoghurt (½ tablespoon)
½ serve a day Breastmilk / 100 ml infant formula
One serve = 20g fresh fruit is best but frozen and canned Mid-morning
(with no added sugar) are also good alternatives.
Breastmilk / 150 ml infant formula
Lean meats and poultry, fish, eggs, tofu
Lunch
1 serve daily
Blended/mashed meat (1 tablespoon)
One serve = 30g cooked meat or 40g cooked chicken or
Blended/mashed vegetables (1 tablespoon)
50g cooked fish or 1 egg or 85g tofu.
Bread cut into pieces (½ slice) or cooked pasta/rice (¼
Breastmilk or formula cup)
600ml Breastmilk / 100 ml infant formula

Yoghurt/cheese or alternatives Mid-afternoon

½ serve daily Breastmilk / 150 ml infant formula
One serve = 20g yoghurt or 10g cheese, choose full Dinner
cream varieties.
Blended/mashed meat (1 tablespoon)
For more information see www.eatforhealth.gov.au. Blended/mashed vegetables (1 tablespoon)
Cooked Pasta or rice (½ cup)
Breastmilk / 100 ml infant formula
74
Introducing solid foods
Feeding from 12 months
Your child can now eat a wide range of family foods. This is a time for learning the social skills of eating
together as a family.
Foods to add in Encourage your child to feed themselves.
• Full cream cows milk
Do not force your child to finish all of their food.
• Regular (unboiled) water
Your baby is now mobile and exploring and so will be
• Infant formula can be replaced by full cream cows milk.
exposed to more infections. Making sure he or she is
Limit cows milk intake to around 500 ml to leave
eating healthy food will help protect against infection, as
enough room for solid foods.
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 Plan regular meal and snack times and allow enough time
meals and meal times with the rest of the family. As much for your child to eat a meal.
as possible, offer ‘family meals’. Children do not need Do not add sugar and salt to basic foods.
special foods. If you need to, just modify the texture of
Be consistent!
the food you are eating, e.g. cut up meats, or serve small
pasta pieces that are easy for your child to pick up. If food choices are limited or you have special diet needs,
seek advice from a dietitian, child health nurse or other
This is a great time for learning and exploring. Give
suitably qualified health professional.
a variety of foods. Some foods won’t be well accepted
until your child tastes them 10–20 times. So be patient!
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 Grain (cereal) foods, mostly whole grain and/or high
Continue to breastfeed as often as your child desires and cereal fibre varieties
you are able. The use of formula or follow-on formula after 4 serves a day
12 months is not necessary. Solid foods should provide One serve = one slice of bread, or ½ medium roll or flat bread
an increasing proportion of energy intake after 12 or ½ cup cooked rice, pasta, noodles, porridge or polenta,
months. After 12 months, water and full cream cows milk barley, buckwheat, semolina, cornmeal, quinoa, bulgur,
should be the main drinks offered, from a cup. quinoa or 3 crisp breads, 1 English muffin or scone or crumpet .

Frequent consumption of sugary drinks is associated with Vegetables and legumes/beans

increased risk of infant tooth decay. Fruit juice is also 2–3 serves a day
acidic and can increase the risk of infant tooth decay and One serve = ½ cup or 4 tablespoons of cooked vegetables or
erosion. It is especially important to avoid feeding these legumes or 1 cup green leafy or raw vegetables.
drinks from baby bottles. 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
Planning meals from 12 months best but frozen and canned are also good alternatives.
There may be some variations in nutritional needs due to
growth and different activity levels, but it is important to
Fruit
keep providing a variety of foods from the Five Food ½ serve a day
Groups. (see www.eatforhealth.gov.au/food-essentials/ One serve = 1 medium apple, banana, orange or pear; or 2
five-food-groups). The servings listed here provide a small apricots, kiwi fruits, or plums; or 1 cup diced fruit; or
general guide for toddlers aged around 1–2 years. only occasionally ½ cup of fruit juice (no added sugar); or
Appropriate growth and development will also indicate 30g dried fruit (4 dried apricot halves, 1½ tablespoons of
whether food intake is at an appropriate overall level for sultanas).
your child. 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
76 sticks to teeth, which can contribute to infant tooth decay.
Milk, yoghurt, cheese and/or alternatives Breakfast
1–1½ serves a day Breastfeed
One serve = 1 cup milk or 200g yoghurt or 40g cheese or Cereal with milk
½ cup ricotta cheese or 1 cup of soy, rice or other cereal Fruit
drink with at least 100mg of calcium per 100ml. Mid-morning
Choose full cream fat varieties, as reduced fat milk, 1 slice toast or crackers with spread
yoghurt and cheese products are not recommended for Water
children under 2 years. Continue to breastfeed on demand
for as long as you and your baby would like to. Lunch
Meat/chicken/fish/egg/legumes
Lean meats and poultry, fish, eggs, tofu, nuts,
Vegetables (raw or cooked)
seeds, and legumes/beans
Bread or Pasta/rice/noodles(e.g. chicken or egg sandwich
1 serve daily with cucumber sticks and cherry tomatoes)
One serve = 65g cooked meat, 80g cooked chicken, 100g
cooked fish or 2 eggs or 1 cup cooked or canned legumes/ Mid-afternoon
beans or 170g tofu or 30g or nut or seed paste (peanut or 1 small carton yoghurt
almond butter or tahini). Water
Red meat is an excellent source of iron. Try to include it
Dinner
often. Nuts are not recommended for young children as
they may cause choking. Use only smooth nut pastes. Meat/chicken/fish/egg/legumes
Vegetables (raw or cooked)
For more information see www.eatforhealth.gov.au. Pasta/rice/noodles
Sample menu 12 months Supper
This sample menu gives an example of how these foods Breastfeed/milk
could be eaten over the day. 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
• minced meat and pasta shells on themselves
• 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
• risottos and pastas made with vegetables
into a face. Sometimes raw vegetables are accepted
• diced meats better than cooked.
• cheese
Try varying the way you serve a vegetable to improve its
• food cut into different shapes, e.g. melon balls, acceptance, e.g. mashed potato might be more popular
use biscuit cutters for different sandwich shapes than boiled potato. Grated carrot in a bolognese sauce
• pikelets might be eaten when carrot pieces aren’t.
• little fruit and vegetables, e.g. cherry tomatoes, grapes
• noodles
Remember
• Food can be simple. It does not need to be complex.
• spaghetti and all different shapes of pasta
• Adapt family food to suit your baby’s developmental
• boiled or scrambled egg
stage.
• potato patties
• If you are using commercially prepared food, start with
• home-made pizza fingers single ingredients such as apple or sweet potato. Only
• mini chicken drumsticks use commercially prepared food sometimes as they do
• meatballs not offer enough variety in foods, textures and tastes.
• baked beans
78
Introducing solid foods
Recipes for babies
When preparing food for your baby use a variety of foods 1. Pureed vegetables
and avoid adding salt, sugar or honey. Your baby’s taste
buds are more concentrated than ours and it is important Ingredients
to develop a taste for the natural flavour of foods. (finely chopped)
1 small potato, peeled
Babies and children do not need special foods. By
1 small piece pumpkin, peeled
12 months your baby should be eating the same healthy
½ cup carrot, grated
meals as the rest of the family. At earliest stages, the
1 small piece green leafy vegetable
easiest approach is to take part of your family meal and
(broccoli, zucchini, lettuce)
change its texture to suit their developmental stage.
For example, from 6 months, a roast for the rest of the Method
family could become pureed potato, pumpkin and beans Using a steamer or saucepan, bring a small amount of
for your baby with finely chopped and pureed meat water to the boil.
blended with meat juices. Children like to watch and Add the vegetables, cover with a tight-fitting lid and cook
imitate people around them. This may be a time to quickly until vegetables are soft.
reassess your own food choices.
Press vegetables through a strainer or puree in a blender
Expressed breastmilk, infant formula or cows milk may or food processor.
be used in recipes for babies. All the recipes can be given
from 6 to 8 months depending on the developmental Offer the new food at the beginning of feeding time when
stage of your baby. your baby is hungry. This will increase acceptance of new
flavours.
As you become more confident feeding your baby, you will
be able to develop your own recipes. Here are some to get
you started.

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 ¼ cup of lean meat (e.g. chicken, beef, veal, lamb) – finely
(stones removed) 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 Place meat and sweet potato in a saucepan with enough
water to cover fruit for at least 15 minutes before cooking. 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 Press through a sieve or blend to a smooth consistency
bottom of the saucepan and cook quickly until fruit is and serve.
soft.
4. Rusks
Press pulp through a strainer or puree in a blender.
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.
Allow to cool, then store in an airtight container in
the refrigerator. Use as required. Store for a maximum
80 of 1 week.
5. Pureed steamed fish 7. Milk custard
Ingredients Ingredients
1 fillet of fish 1 tablespoon cornflour
250ml milk
Method ½ teaspoon vanilla essence
Place fish in a steamer or saucepan with a small amount 1 tablespoon pureed fruit of choice
of water.
Method
Cover and steam until fish is well cooked.
Place cornflour and vanilla in a saucepan and mix to a
Carefully remove all bones and skin and press through smooth paste with a little milk.
a strainer or puree in a blender.
Stir in the remaining milk.
The fish may be served with white sauce from 9 months.
Over medium heat, slowly bring to the boil, stirring
6. Banana rice pudding continuously for approximately for 10–15 minutes until
thickened.
Ingredients Remove from heat, stir and pour into bowl.
¾ cup cooked rice
Allow to cool slightly, then refrigerate to set.
¾ cup (180ml) full cream milk
½ teaspoon vanilla essence Serve with the pureed fruit.
½ banana – mashed

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 1 egg
½ teaspoon butter or oil 150ml milk
100ml milk
1 tablespoon finely chopped cooked chicken (no skin) Method
Whisk egg and milk.
Method
Pour mixture into a nonstick frypan and cook
Over a gentle heat, blend flour and butter in a small over a low heat, stirring occasionally with a fork.
saucepan until a paste is formed.
When cooked, cool slightly and serve.
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
10. Baked egg custard 11. Mince stew
Ingredients Ingredients
1 egg ¼ finely chopped onion
150ml full cream milk ½ diced carrot
½ teaspoon vanilla essence ½ stick of celery finely chopped
1 tablespoon pureed fruit 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 When onion is soft, add in carrot, celery and stir.
cup – 250ml). Stand in a baking dish containing enough When these vegetables have slightly softened,
water to come halfway up the side of the ovenproof dish. add in mince and brown thoroughly.
Bake in a moderate oven (180o C) for approximately Add a little water if needed. This will also help
25–30 minutes or until custard is set. break up the mince and form a sauce.
Serve when warm or cold with pureed fruit.

83
 Solids guide
From around 6 months
Around 6 months 6 – 12 months 12+ months
Food High iron foods (e.g. baby rice A variety of healthy foods A variety of healthy foods
cereal or pureed meat) made excluding choking hazards excluding choking hazards
up with expressed breastmilk, (e.g. nuts, popcorn, lollies): (e.g. nuts, popcorn, lollies):
formula or boiled water. • soft/cooked vegetables • 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 added salt or sugar • No added salt or sugar
• No honey • 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 • Fruit juice is not necessary • Regular (unboiled) water from a
cup
84
• Fruit juice is not necessary
Physical activity
Physical activity from birth to one year is important for Tips
health. It is important for you to make time to play with • Help your baby be physically active several times a
your baby. day in a variety of ways, particularly through
For healthy development in infants (birth to one year), supervised interactive floor-based play, including
physical activity, particularly supervised floor-based play crawling; more is better.
in safe environments, should be encouraged from birth. • For those not yet mobile, ensure there is at least 30
Following the guidelines on physical activity, sedentary minutes of tummy time which includes reaching,
behaviour and sleep during a child’s early years is grasping, pushing and pulling, spread throughout
associated with better growth, stronger muscles and the day while awake.
bones; better learning and thinking; better mental, • Ensure your baby is not restrained for more than 1
emotional and social well-being; better motor skills; as hour at a time (e.g. in a stroller, car seat or high
well as reduced injuries. chair).
Activity or movement in the first 6 months of life includes • Help your baby get comfortable with the world
reaching for and grasping objects, turning the head around them and introduce them to the sounds,
toward stimuli (sound, movement or touch), and sights and feel of the outdoor environment. But
movement of arms and legs whilst lying on the stomach always remember sun safety – see the sun
(‘tummy-time’). protection tips on the next page.
The second 6 months of life are characterised by learning • Sleep time is also important. Although no 2 days will
basic movement skills such as crawling, pulling up to a be the same, as a guide you should aim for babies
standing position, creeping whilst using an object for 0–3 months to be getting 14–17 hours sleep per day
support, and finally, walking. including naps and babies 4–11 months to be
getting 12–16 hours.

85
 Physical Activity
No screen-time Sun protection
No Screen time • Baby’s and young children’s skin is very sensitive and
When sedentary (sitting or lying down, except when susceptible to sunburn. Infants under 12 months
sleeping) children should engage in pursuits such as should not be intentionally exposed to direct sunlight.
reading, singing, puzzles and storytelling with a caregiver. • Plan your daily activities to ensure your baby is well
No screen-time is recommended for children less than two protected from the sun, try to schedule outdoor
years of age. This includes iPads, electronic phones and activities for the early morning or late afternoon.
tablets • Using physical/barrier protection methods such as
shade, elbow length or longer collared shirts, knee
Although a variety of TV programs have been created for
length or longer shorts/dresses/skirts and broad brim,
children under 2 years, it is questionable whether TV
bucket or legionnaire style hats are the best sun
enhances development in the first 2 years of life.
protection measures for all babies and children. Ensure
The most important factor for parents and carers to hat straps do not become a choking hazard.
consider is the undeniable benefits associated with • Babies should not be exposed to direct or indirect
children participating in active play and interacting with sunlight to treat nappy rash or neonatal jaundice, as
others. Through play and interaction, young children learn this puts them at high risk of sunburn and skin damage.
valuable movement and communication skills.
• Apply a broad-spectrum SPF 30 or higher sunscreen
For more information designed for children or sensitive skin on areas that are
• Department of Health: not covered by clothing at least 20 minutes before
Australian 24-Hour Movement Guidelines for the Early going outside and remember to reapply every 2 hours.
Years (birth to 5 years): An integration of Physical • Use sunglasses if practical to protect your baby’s eyes.
Activity, sedentary behaviour, and sleep. Infant sunglasses are available with soft elastic to keep
www.health.gov.au. them in place.

86
Acknowledgements
Breastfeeding and infant nutrition When your child is sick
The chapters on infant nutrition are consistent with This section draws on information from:
the National Breastfeeding Strategy 2010–15. • Giving Medication, The Centre for Community Child
Information is drawn from: Health, Royal Children’s Hospital Melbourne, 2005
• Using Paracetamol or Ibuprofen, Children, Women's
• Infant Feeding Guidelines, National Health and Medical
and Children's Health Network – www.cyh.com
Research Council, 2013 www.eatforhealth.gov.au
Breastfeeding and your baby, Queensland Health, • Children - When to See the Doctor,
www.qld.gov.au/health/children/babies/breastfeeding Better Health Channel – www.betterhealth.vic.gov.au
• Growing Strong: Feeding You and Your Baby, (for • Fever in Children, The Royal Children’s Hospital
Aboriginal and Torres Strait Islander families) Public Melbourne www.rch.org.au/kidsinfo/fact_sheets/
Health Queensland, Queensland Health, Fever_in_children/
www.health.qld.gov.au/nutrition/pregnancy- • Parent Information About Children with High
indigenous Temperatures, Department of Paediatric Emergency
• Good start to life (for Maori and Pacific Islander children Medicine, The Mater Misericordiae Children’s Hospital.
and families) www.childrens.health.qld.gov.au/chq/ This information is provided as general information only and should
our-services/community-health-services/good-start- not be relied upon as professional or medical advice. Professional
program/ 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
Thank you production.

This booklet is the result of input and effort from many The State of Queensland (Queensland Health) does not accept liability
to any person for the information provided in this booklet nor does it
health professionals in Queensland. Their assistance
warrant that the information will remain correct and current.
with the content for this booklet is greatly appreciated.
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) Lactation Consultants of Australia and New Zealand
1800 177 833 (free call) www.qld.gov.au/health/staying- 02 9431 8621 www.lcanz.org
healthy/atods Lifeline (24-hour hotline)
Australian Breastfeeding Association 13 11 14 (free call) www.lifeline.org.au
1800 686 268 (free call) www.breastfeeding.asn.au Make Smoking History
Breastfeeding information (Queensland Health) Quitline: 137848 makesmokinghistory.org.au
www.health.qld.gov.au/breastfeeding PANDA (Perinatal Anxiety & Depression Association)
Beyond Blue (pregnancy and early parenthood) 1300 726 306 (helpline) www.panda.org.au
1300 22 4636 www.beyondblue.org.au
Queensland Poisons Information Centre (24-hour hotline)
Children’s Health Queensland 13 11 26 www.health.qld.gov.au/poisonsinformationcentre
www.childrens.health.qld.gov.au
Queensland Centre for Perinatal and Infant Mental Health
Child Safety After Hours Service Centre www.childrens.health.qld.gov.au/chq/our-services/mental-
1800 177 135 (free call) / 07 3235 9999 (Brisbane) health-services/qcpimh
DV Connect (domestic violence hotline) Raising Children Network
www.dvconnect.org Women: 1800 811 811 (24hr, 7 days) www.raisingchildren.net.au
Men: 1800 600 636 (9 am-12.00 midnight, 7 days)
Red Nose (SIDS and Kids) (24-hour support line)
Ellen Barron Family Centre 1300 308 307 www.rednose.com.au
(parenting support service – by referral only) 07 3139 6500
www.childrens.health.qld.gov.au/ellen-barron-family-centre True (Family Planning Queensland)
07 3250 0200 www.true.org.au (lists local clinics)
Immunise Australia Program
1800 671 811 (free call) www.immunise.health.gov.au Women’s Health Queensland Wide Inc
Australian Childhood Immunisation Register 1800 017 676 (free call) / 07 3216 0376 (Brisbane)
www.womhealth.org.au
1800 653 809 (free call)
Immunisation information (Queensland Health)
13 HEALTH (24-hour health information and advice hotline)
13 43 25 84 Ask for the Child Health Nurse
www.qld.gov.au/health/conditions/immunisation
www.health.qld.gov.au/13health
Kidsafe Queensland Note: If you have difficulty connecting, try dialing only the first six digits
07 3854 1829 www.kidsafeqld.com.au of the phone number (13 43 25).

6/2018 www.facebook.com/childrenshealthqld