Breastmilk is the only food your baby needs until at
least 4 months of age and most babies do very well on
breastmilk alone for 6 months or more. There is no advantage
to adding other sorts of foods or milks to breastmilk before
4 to 6 months, except under unusual or extraordinary
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. When the mother's milk becomes more
plentiful, after 3-7 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
breastfeeding. The baby must latch on well so he can get the
mother's milk which 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.
Water
Breastmilk is over 90% water. Babies breastfeeding well do
not require extra water, even in summer. If they are not
breastfeeding well, they also do not need extra water, but
require that the breastfeeding be fixed. Babies do not need
extra water even in hot weather.
Vitamin D
It seems that breastmilk does not contain much vitamin D. We
must assume this is as nature intended, not a mistake of
evolution. The baby stores up vitamin D during the pregnancy
and he will remain healthy without vitamin D
supplementation, unless you yourself were vitamin D
deficient during the pregnancy. Vitamin D deficiency in
pregnant women in Canada is rare. Outside exposure also
gives your baby vitamin D even in winter, even when the sky
is covered. 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 extra vitamin D 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 available iron in order to multiply. The iron in
breastmilk is very well utilised 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
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 the table 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. 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 best way for the baby of getting
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.
(See also handout #16 Starting Solid Foods)
Breastmilk, cow's milk, formula, outside work and bottles
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. 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.
(See also handout #17 What to feed the baby when the mother
is working outside the home)
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 disadvantage. Even at this age
a baby may start to prefer the bottle if he seems not to
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 simple techniques,
to get the baby gaining well, and/or to be satisfied with
breastfeeding alone. Check with your doctor.
Handout #10. Breastfeeding and Other Foods. Revised
January 1998 Written by Jack Newman, MD, FRCPC
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