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Introduction
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 (Breast Compression)
do not get the baby breastfeeding, then supplementation, if medically
needed, can be given by lactation aid
(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, even in the hottest weather. If they are not
breastfeeding well, they also do not need extra water, but require that the
breastfeeding be fixed.
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. 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 (see also
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. 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 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
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 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 doctor or clinic.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Breastfeeding
and Other Foods" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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