Breastfeeding
and Other Foods 
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.
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.
Breastmilk, cow's milk, formula, outside work and
bottles (see also handout #17 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 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 the clinic.
Handout #10. Breastfeeding and Other Foods. Revised
January 1998
Written by Jack Newman, MD, FRCPC
May be copied and distributed without further
permission
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