Feeding Your Infant with Congenital Heart Disease

Feeding your baby is an opportunity for you to love, touch, and communicate with your infant. Feeding provides nutrition for your baby's physical and mental growth. Babies with congenital heart disease can be a challenge to feed. Some babies may not gain weight even with your hard work. This booklet will give you information to help you learn about your baby's special needs.

Your Baby's Growth 

If your baby has congenital heart disease it means that the heart or the blood vessels near the heart did not develop normally before birth. Congenital heart defect is another name used for congenital heart disease.

Healthy babies usually double their birth weight between four and five months of age. A baby with congenital heart disease may grow more slowly during infancy and childhood. Babies gain or lose weight from day-to-day since appetites vary. Even if your baby seems to drink enough formula or breast milk, he or she may gain weight slowly. It is not necessary to try to weigh your baby often at home. Your baby's health care provider will weigh your baby on the same scale at each office visit. These weight measurements will show how your baby is growing.

Babies with congestive heart failure tend to grow normally in height, but gain weight slowly. Congestive heart failure (CHF) happens when the heart muscle has to work harder than normal. It does not mean that the heart "fails" to beat. CHF is usually treated with medicine that helps strengthen the heart muscle and gets rid of extra fluid in the body.

Some of the reasons that infants with congenital heart disease grow slowly include:

• A fast heart beat

• Breathing harder and faster

• A poor appetite

• The need for extra calories by the heart and lungs

• Poor digestion of food

• Tiring easily/ falls asleep with feeding

• Frequent colds 

How to Feed Your Baby

Before your baby was diagnosed with a heart problem, you may have already decided to breast or bottle feed. Both of these methods can work well for babies with heart problems, but it is important to be flexible about your feeding method. With either breast-feeding or bottle-feeding, your baby may need extra calories. These extra calories can be given in a variety of ways. Methods of feeding will be discussed in the next few sections of this pamphlet.

Feeding Tips

1. What can I do if the baby falls asleep every time I try to feed him or her?
   
   Babies may be sleepy and may not seem interested in eating. If so, the baby should be unwrapped and stimulated by gently massaging feet to awaken for feedings. If your baby does not get fussy when hungry, you need to watch for feeding cues. Signs that your baby is ready to eat may include: body and mouth movements, eyes opening, and bringing hands to the mouth.
   
   

2. What should my baby eat?
   
   Babies with heart disease may not be able to eat large feedings. Increasing the 
   amount of calories in the breast milk or formula may be necessary. Each ounce 
   of regular formula or breast milk has about 20 calories. Your doctor, nurse, or 
   dietitian may suggest ways to increase these calories if your infant is growing 
   slowly. Most babies do not need plain water because it does not have any calories. 
   After four months of age, juice can be given to your infant, but it should not 
   replace formula. Milk has more calories than solid foods or juices. Formula or 
   breast milk is still the best way to give your baby calories. 
   
   

3. How often should I feed my baby?
   
   All infants are individuals. They vary in how often they eat and how much formula or breast milk they take per feeding. Try not to compare the amount of milk your baby takes to the amount taken by other babies take since they are all different. Your baby may eat every two to three hours. Babies with congenital heart disease typically do best when fed more often and on a demand schedule. They tend to tire quickly during the feeding, so frequent feedings work better. Newborns will often feed every two or three hours even at night.
   
   Ask your baby's health care provider about how much and how often your baby should eat.
   

If you plan to nurse your baby, it is important to develop your milk supply. If it is not possible to nurse your baby after delivery, or at any other time, you should use a breast pump to maintain your milk supply.

1. How can I keep up my milk supply when the baby cannot breast feed?
   
   You will need to pump at the hospital and at home. You may need to pump at least 4 to 5 times per day. If your baby is older, you will need to pump as often as the baby was nursing. Remember to drink at least 8 glasses of fluid per day
   
   
2. How will breast feeding help my baby?
   
   There are many benefits of breast-feeding. Breast-feeding creates a special closeness between you and your baby. Breast milk is perhaps the best nutrition for your baby. It's the perfect food for your baby's growth and developmental needs. It is easier to digest than formula. Breast milk also contains natural antibodies which help your baby fight infection.
   
   
3. Once my baby is breast-feeding, how can I tell if he or she is getting enough milk?
   
   The baby is probably getting enough milk if you are nursing regularly and the baby is latching on well. Your baby should have at least 6 to 8 wet diapers per day. A consistent weight gain will also tell you that your baby is getting enough milk. 

Formula Feeding Your Baby

Another acceptable way to feed your baby is by bottle.  Bottle feeding also allows        other family members to become more active in feeding.  Breast fed babies may receive formula supplementation while at home or in the hospital.

1. How do I choose a formula?
   
   Commercial formulas are made as nearly like breast milk as possible. You and your baby's healthcare provider can decide which formula is best.
   
   
2. Which bottle and nipple should I use?
   
   There are many types of baby bottles and nipples. It may take several trials with various bottles and nipples before you find one that works best for your baby. Some babies with heart disease have difficulty feeding from a regular nipple. You may want to find a soft nipple or make a larger hole in the nipple to allow the formula to flow more easily. Small holes in the nipple make it more difficult for your baby to suck and he or she may swallow air, which may result in vomiting. You can enlarge the hole in the nipple by inserting a sterilized sewing needle into the hole and tearing the hole open a little. The nipple and bottle should always be clean.

TUBE FEEDINGS

Some babies may be too tired or unable to eat enough by breast or bottle-feeding.  There are a variety of options, including tube feedings, to help when this happens.  You and your healthcare team will determine the best method for feeding in this case.

STARTING ON SOLID FOODS

Your health care provider will help you determine when solid food should be added to your baby’s diet.  Cereals fortified with iron are typically introduced first, followed by fruits and vegetables, and then meats.

1. Gradually increase the texture of food offered from pureed to lumpy and then small pieces of soft table food. By nine to twelve months of age your child should be able to finger-feed soft table foods. Breast milk or formula should be continued until at least one year of age.
   
   
2. Parents sometimes think children with congenital heart disease need to eat 
   special diets that are low in fat, similar to low fat diets recommended for adults 
   with heart disease. In fact, since children with congenital heart disease often 
   have poor appetites, high calorie foods and snacks can play a very important role 
   in providing good nutrition. Fat should not be restricted in their diet, particularly 
   in the first 2 years of life. Fat is needed to help children grow and develop 
   properly. Therefore, lower fat milk (2%, 1%, or skim) is not recommended until 
   children are at least 2 years of age or older. 

ASKING FOR HELP

Feel free to ask your health care provider or a dietitian for advice in determining how best to meet your baby’s needs.  They can discuss these various feeding methods with you and suggest ways to boost the amount of calories in your child’s diet.

HEART MEDICINE AND FEEDING

Many babies with congenital heart disease are given medicines.  These medications usually do not interfere with feedings.  It is best to give medicine to your baby before feedings.  Give the medication directly into your baby’s mouth using a syringe or dropper from the medication bottle.  Do not mix medicine in the bottle of formula because your baby may not finish the bottle.  If the baby vomits after the medication, do not repeat it.  Give the normal (regular) dose next time it is due. 

You should contact your health care provider if your baby becomes ill, feeds poorly, vomits more than two or three feedings per day, or has less wet diapers than usual.

LOOKING AHEAD

Persistent and loving efforts to feed your baby will be rewarded.  Even when your baby does not eat well, just being physically close to you during feeding times is important.  Feeding your baby should be a positive experience, never a battleground.  Children with heart disease often reach satisfactory growth by the time they become adolescents.  Take time to enjoy feeding your baby.

Common Problems

A portion of this document is from the American Heart Association, Inc.  All rights reserved.  Unauthorized use prohibited.