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 (see Breast
Compression) do not get the baby breastfeeding, then
supplementation, if medically needed, can be given by lactation aid
(see Using a 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 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 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
6-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 6 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. 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 disadvantage. Even at this age a baby may start
to prefer the bottle if he seems to not 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 simple techniques, to get the baby gaining well and/or
to be satisfied with breastfeeding alone. Check with the clinic.
This article may
be copied and distributed without further permission
 About the
Author
JACK NEWMAN
graduated from the University of Toronto medical school as a pediatrician in 1970. He
started the first hospital-based breastfeeding clinic in Canada in 1984 at Toronto's
Hospital for Sick Children. He has been a consultant with UNICEF for the Baby Friendly
Hospital Initiative in Africa, and has published articles on the subject of breastfeeding
in Scientific American and several medical journals. Dr. Newman has practiced as a
physician in Canada, New Zealand, and South Africa.
If you would like to contact Dr. Newman, you can mail him at: newman@globalserve.net
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