Guidance on How to Effectively Breastfeed Your Baby

Breastfed Babies Need Vitamin D and Iron Supplementation

Young woman kissing a baby's hand while breast feeding
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Breast milk is the only food your baby needs until at least 4 months of age, and most babies do very well on breast milk alone for 6 months or more. There is no advantage to adding other sorts of foods or milks to breast milk before 4 to 6 months, except under unusual or extraordinary circumstances. Many of the situations in which breast milk seems to require addition of other foods arise from misunderstandings about how breastfeeding works or originate from a poor start at establishing breastfeeding.

Supplementing Breast Milk 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 to 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 do not get the baby breastfeeding, then supplementation, if medically needed, can be given by lactation aid. If your baby is taking the breast, the lactation aid is a far better way to supplement than finger feeding or cup feeding.

But remember, getting the baby well latched on first works most of the time and no supplements will be needed.

Breast Milk: Water

Breast milk 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.

Breast Milk: Vitamin D

In 2008, the American Academy of Pediatrics recommended that all babies and children receive 400 IU/day. Breastfed babies typically receive about 25 IU/day of vitamin D from milk alone and thus need vitamin D supplementation.

It seems that breastmilk does not contain much vitamin D, but it has a little. The baby stores up vitamin D during the pregnancy and she will remain healthy without vitamin D supplementation, unless you yourself were vitamin D deficient during the pregnancy. Vitamin D deficiency in pregnant women in the United States and Canada is rare. Outside exposure to sunlight also gives your baby vitamin D even in winter, even on cloudy days.

An hour or so of outside exposure during a week gives your baby more than enough vitamin D even if only her face is exposed, even in winter.

Breast Milk: Iron

Iron deficiency is the most common nutrient deficiency in the world. A lack of iron can lead to neurological and developmental problems. The American Academy of Pediatrics recommends that all babies aged 4 months and more receive iron supplementation.

Solid Foods and Breastfed Babies

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 to 9 months of age. 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 cereal, 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' plate that can be mashed with a fork.

Far fewer feeding problems will occur if a relaxed approach to feeding is taken.

Breast Milk, 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. In fact, she 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 to 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 her food and liquid off a spoon when the mother is not with her. As she 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 she refuses to accept one. Your baby is not being stubborn, but does not know how to use an artificial nipple. She also may not like the taste of formula, which is understandable.

The breastfeeding baby can take some of her milk as cow's milk after about 6 months of age, especially if she 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.

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