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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.
Solid Foods (see
also handout #16 Starting
Solid Foods)
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.
Breastmilk, cow's
milk, formula, outside work and bottles
(see also handout #17 What
to feed the baby when the mother is working
outside the home)
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? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or 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
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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