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Breastfeeding and Other Foods
Handout #10. Breastfeeding and Other Foods.
Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Introduction
Breastmilk is the only food your baby needs until about 6 months
of age. There is no advantage to adding other sorts of foods or
milks to breastmilk before about 6 months, except under unusual
circumstances. Many of the situations in which breastmilk seems
to require addition of other foods arise from misunderstandings
about how breastfeeding works, and/or originate from a poor start
at establishing breastfeeding.
Supplementing during the first few
days
It is thought by many that there is "no milk" during
the first few days after the baby is born, and that until the milk
"comes in" some sort of supplementation is necessary.
This idea seems to be born out by the fact that babies, during the
first few days, will often seem to feed for long periods
and yet, not be satisfied. However, the key phrase is that "babies
seem to feed" for hours, when in fact, they are not
really feeding much at all. A baby cannot get milk efficiently when
he is not latched on properly to the breast, particularly when the
supply is not yet abundant. When the mother's milk becomes more
plentiful, after 3-4 days, the baby may do well even if he is not
well latched on. But during the first few days, if the baby is not
latched on properly, he cannot get milk easily and thus may "seem
to feed" for very long periods. There is a difference between
being "on the breast" and drinking milk at the breast.
The baby must latch on well so he can get the mother's
milk that is there in sufficient quantity for his needs, as nature
intended. If a better latch, and compression (Handout #15 Breast
Compression) do not get the baby breastfeeding,
then supplementation, if medically needed,
can be given by lactation aid (handout #5 Lactation
Aid). The lactation aid is a far better way to supplement
than finger feeding or cup feeding, if the baby is taking the breast.
And it is much, much better than using a bottle. But remember,
getting the baby well latched on first and using compression work
most of the time and no supplements will be needed.
Water
Breastmilk is over 90% water. Babies breastfeeding well
do not require extra water, even in summer, even in the hottest
weather. If they are not breastfeeding well, they
also do not need extra water, but rather, the mother should
be helped so that breastfeeding works better.
Vitamin D
It seems that breastmilk does not contain much vitamin
D, but it has a little. We must assume this is as nature intended,
not a mistake of evolution. In fact, breastmilk is one of the few
natural foods that does contain some vitamin D. The baby stores
up vitamin D during the pregnancy and he will remain healthy without
vitamin D supplementation, unless the mother herself is vitamin
D deficient during the pregnancy. Vitamin D deficiency in pregnant
women in Canada and the USA is rare. Outside
exposure also gives your baby vitamin D even in winter, even when
the sky is cloudy. An hour or so of outside exposure during a week
gives your baby more than enough vitamin D even if only his face
is exposed, even in winter.
Under unusual circumstances, it may be prudent to give the baby
vitamin D. For example, in situations where exposure of the baby
to ultraviolet rays of the sun is not possible (Northern Canada
in winter, or if the baby is never taken outside), giving
the baby vitamin D drops would be advised. Vitamin D drops are expensive.
Iron
Breastmilk contains much less iron than formulas, especially the
iron enriched formulas. Actually, this seems to give the baby extra
protection against infection, as many bacteria require iron in order
to multiply. The iron in breastmilk is very well utilized by the
baby (about 50% is absorbed), while being unavailable to bacteria,
and the breastfed full term baby does not need any additional iron
before about 6 months of age. However, introduction of iron containing
foods should not be delayed much beyond 6 months of age.
Breastfed babies normally do not require solid foods before 6 months
of age. Indeed, many do not require solid foods until 9 months or
more of age, if we can judge by their weight gain and iron status.
However, there are some babies who will have great difficulty learning
to accept solid food if not started before 7-9 months of age. Because
the six-month-old baby will also soon need to have an additional
source of iron, it is generally recommended and convenient that
solids be introduced around 6 months of age. Some babies show great
interest in grabbing food off your plate by 5 months, and there
is no reason not to allow them to start taking the food and playing
with it and putting it in their mouths and eating it.
It has been the habit of physicians to suggest that babies be started
first on cereals and then other foods be added. However, the 6 month
old is far different from the 4 month old. Many 6-month-old babies
do not seem to like cereal if it is introduced at this time. Do
not push the baby to take it, but offer other foods, and perhaps
try again when your baby is a little older if you really want him
to take cereal. But if he refuses, do not worry he will be missing
something. There is nothing magic about cereal and babies do fine
without it. Anyhow, your baby may soon be eating bread. The easiest
way for the baby to get additional iron is by eating meat.
There is no good reason why a baby needs to eat or be introduced
to only one food per week, or why vegetables should be started before
fruits. Anyone worried about the sweetness of fruit has not tasted
breastmilk. The six-month-old can be given almost anything off his
parents' plate that can be mashed with a fork.
Far fewer feeding problems will occur if a relaxed approach to
feeding is taken.
A breastfeeding baby who is older than about 4 months will not
likely take a bottle if he has not already gotten used to one. In
fact, he may decide not to take one even if he was taking one before.
This is no loss or disadvantage. At about 6 months or even younger,
the baby can start learning to use a cup, and usually will be quite
good at drinking from a cup by about 7-8 months of age, if not sooner.
If the mother is returning to paid work at about 6 months, there
is also no need to start bottles or formula. In this situation,
solids may be started somewhat earlier than 6 months of age (say
4 or 5 months of age), so that by the time the mother is working
outside the home, the baby can be getting most of his food and liquid
off a spoon when the mother is not with him. As he gets older, the
cup may be used more and more for liquids. You and the baby can
manage without his taking bottles. Do not try to starve
the baby into taking a bottle if he refuses to accept one.
Your baby is not being stubborn, but does not know how to use an
artificial nipple. He also may not like the taste of formula, which
is understandable.
Though there has been a lot of publicity recently about not giving
babies cow's milk until at least 9 months, this does not really
apply to breastfeeding babies. The breastfeeding baby can take some
of his milk as cow's milk after about 6 months of age, especially
if he is starting to take substantial amounts of a wide variety
of solids as well. Goat's milk is an alternative. Many breastfeeding
babies will not drink formula because they do not like the taste.
Actually, the breastfeeding baby can get all the milk he needs from
the breast without his requiring other sorts of milk, even if he
is nursing only a few times a day.
My 4 month old is hungry on breast
only. Solids or Formula?
There is no advantage in this situation of giving formula by bottle
and there may be some disadvantages. Even at this age a baby may
start to prefer the bottle if he seems not to be getting enough
from the breast (if, in fact, he will accept a bottle). It would
be preferable in this circumstance to give solids off a spoon rather
than to give formula in a bottle. (Frequently, however, this situation
can be remedied differently by improving the breastfeeding—get
help!). If you wish to mix formula with solids, that does
not cause the same sort of problem as giving it in a bottle. If
the baby seems hungry after breastfeeding, feed him solids off a
spoon. However, it may be possible with a few simple techniques,
to get the baby gaining well, and/or to be satisfied with breastfeeding
alone. Check with the clinic.
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #10. Breastfeeding and Other Foods.
Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further permission,
on
the condition that it is not used in any context in which
the WHO code on the marketing of breastmilk substitutes is violated
