Foods and Supplements for the Nursing Baby

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By Dr. Jack Newman

Breast milk is the only food your baby needs until about six months of age. There is no advantage to adding other sorts of foods or milks to breast milk before about six months, except under unusual circumstances. Many of the situations in which breast milk 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 borne out by the fact that babies during the first few days will often seem to feed for long periods and yet not be satisfied.

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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. When the mother’s milk becomes more plentiful, after three to four 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 works most of the time, and no supplements will be needed.

Extra water
Breast milk is more than 90 percent. 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 the breastfeeding must be fixed.

Vitamin D supplements
It seems that breast milk 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, breast milk 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 United States is rare. Outside exposure 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 supplements
Breast milk 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 breast milk is very well utilized by the baby (about 50 percent is absorbed) while being unavailable to bacteria, and the breastfed full-term baby does not need any additional iron before about six months of age. However, the introduction of iron-containing foods should not be delayed much beyond six months of age.

Adding solid foods
Breastfed babies normally do not require solid foods before six months of age. Indeed, many do not require solid foods until nine 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 seven to nine 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 six months of age. Some babies show great interest in grabbing food off your plate by five 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 six-month-old is far different from the four-month-old. Many six-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. 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 his 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 breast milk. The six-month-old can be given almost anything off his parents’ plates that can be mashed with a fork.

Far fewer feeding problems will occur if a relaxed approach to feeding is taken. See also handout #16 Starting Solid Foods.

Breast milk, cow’s milk, formula, outside work and bottles
A breastfeeding baby who is older than about four 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 six 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 seven to eight months of age, if not sooner.

If the mother is returning to paid work at about six months, there is also no need to start bottles or formula. In this situation, solids may be started somewhat earlier than six months of age (say, four or five 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 nine months, this does not really apply to breastfeeding babies. The breastfeeding baby can take some of his milk as cow’s milk after about six 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.

See also handout #17, What to feed the baby when the mother is working outside the home.

My 4-month-old is still hungry; should I add 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 your health care provider.

© Jack Newman, M.D.

Questions? Call Dr. Newman at (416) 813-5757 (option 3), or e-mail [email protected]. Read Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the United States), and visit his website.