Experts in infant nutrition all agree that breast milk is the ideal food for babies as it has just about everything the child needs for optimal nutrition. A baby will usually grow well and be healthy on nothing but breast milk, vitamin D, and iron during the first year of life.
One of the advantages to breastfeeding is the avoidance of food allergies. Allergy to breast milk is very rare. Cow’s milk allergy, on the other hand, occurs in as many as 3% of infants in the US.
There is also some evidence that breastfed babies have fewer respiratory and intestinal infections than formula-fed babies. Breast milk has factors (lactoferrin, immunoglobulins, anti-staphylococcal factor and white blood cells) that inhibit the growth of harmful bacteria in the intestine.
Additionally, breastfeeding is much less expensive than formula.
Though breastfeeding provides a wonderful way for mother and child to bond, mothers who choose bottle feeding should not worry. Whether milk arrives by bottle or breast, parents can still create the relaxed environment, warm cuddles, and skin-to-skin contact that make feeding a bonding experience.
The majority of women can breastfeed, although it’s easier for some women than for others. Some women are just unable to produce enough milk no matter how hard they try, though the size of the breast doesn’t seem to have much to do with the ability to nurse.
There can be great variability in the quality of breast milk, which depends to some extent on the mother’s diet. For example, women who eat a low fat diet after pregnancy will often produce low fat milk and as a result, their baby may receive fewer fatty nutrients from breastfeeding.
Some babies (especially premature infants) do not have a vigorous enough suck to nurse, and some women have inverted nipples, which makes nursing difficult, although not impossible.
At times the nipples get so sore that nursing becomes intolerable. A plugged milk duct or breast infection will sometimes cause a mother to stop nursing. If this happens, call your obstetrician for advice.
If you have any concerns about breastfeeding your infant, talk to your doctor about seeing a lactation consultant.
In order to stimulate your milk supply it is important to:
Mothers can also find free help and advice through the La Leche League in their area.
The first six months are the most important time to nurse. After that there seems to be little documented advantage. Some mothers prefer to breastfeed for up to two years or longer.
Sore nipples are usually caused by improper positioning of the baby on the nipple or by nursing too long. It has been shown that babies get most of the available milk in the first five minutes.
Babies may want to nurse longer because they have a drive to suck. It would be a good idea then to limit nursing to about fifteen minutes on each side the first few days, and then work up to longer periods depending on how tender you are. As the nipples get tougher, you may want to nurse longer or use a pacifier to satisfy the baby’s need to suck.
Washing the nipples with water, soap or alcohol before each feeding causes drying and cracking and is not necessary. Covering the nipples while they are still wet will sometimes cause more soreness. Allow them to dry by exposing them to the air.
Creams or lotions are not recommended, but rubbing some milk on the nipples may help keep them soft. A yeast infection of the nipples can be very painful and can occur even if the baby doesn’t have discernable thrush. If a yeast infection develops, both you and your baby may have to be treated. If you have pain or a burning sensation in your nipples please contact your doctor.
Many infants in the U.S. are started out on formula and do well. Most formulas are made of cow’s milk, which has been modified and fortified to meet a child’s nutritional requirements and processed for easier digestibility.
The best formulas utilize polyunsaturated vegetable fats instead of butter fat and have been fortified with vitamins, zinc, iron and other important elements. It is recommended that all babies be on formula that include iron.
Homogenized milk given to a baby in the first few weeks of life can cause a serious chemical imbalance, which may result in convulsions.
A baby may be able to tolerate homogenized milk after a few months of age, but it is recommended that a child be on formula until 11 to 12 months of age. Too much homogenized milk has been shown to cause microscopic intestinal bleeding and is a common cause of iron deficiency.
A baby should be on a good variety of iron-containing solids before going off formula.
It is impossible to raise your baby in a germ-free environment. Within hours a newborn’s skin, mouth, and intestinal tract are colonized with bacteria.
Many pediatricians recommend cleaning bottles with soap and water just as you would clean your own dishes and utensils. Sterilizing bottles with boiling water is viewed as unnecessary.
A baby’s need to suck may exceed their need to eat. This can last about four months and then subside.
Giving a baby a pacifier (binky or soother) is a great way to calm them down when they are upset, help them to go to sleep, or to delay a feeding for a short time.
Pacifiers have been linked to the spread of infection in day care settings, and the practice of tying one around the neck has resulted in strangulation of some babies. If you use one, it is recommended that you take it away by about 4 to 6 months to avoid the baby becoming too attached to it.
If baby is gaining weight at a normal rate he/she is getting enough food. Generally speaking, if a baby has 4-5 wet diapers in 24 hours, he or she is getting enough food.
An average baby takes 1-3 oz. per feeding between one and two weeks of age, and about 4 – 8 oz by the end of the third month. Overfeeding may cause symptoms of vomiting, colic, gas and diarrhea. It may also create a habit of over eating, which may persist into adult life and lead to obesity.
It is generally agreed that solids should not be started until four to six months. From a developmental point of view, your baby is ready to start when he or she has good neck control when sitting up with support and is showing interest in people around him or her eating food.
Solids are sometimes started earlier in an attempt to help babies sleep better at night. However, studies have shown that most babies given solids at night do not sleep any better.
Giving solids too soon may prove to be difficult because babies under two to three months have an extrusion reflex, which causes them to push out anything that is put in the mouth.
When new foods are introduced into the diet, we recommend that not more than one new food every 2-3 days be given. This gives you time to watch for any signs of allergy that may show up.
The order in which foods are introduced isn’t terribly important, but in general it is recommended in this order:
Most babies don’t care much for plain meat but will take the meat and vegetable combinations. Typically, fruits and juices are saved for last for two reasons: first you don’t want the child to develop a “sweet tooth,” and second, there is less nutritional value in fruit and juices.
Another reason is that breast milk has just barely enough protein for good growth. If many non-protein foods like fruit, puddings, deserts, and juices are given, the baby may not grow as well.
Many baby food labels include stages that suggest at which age a baby can consume them. In general there are four stages:
Stage 1 foods contain single grains, fruits or vegetables, but none of the foods that commonly cause allergy such as milk, wheat, egg, citrus or corn.
Stage 2 foods are combination foods to provide babies 6 months and older with added flavor and variety in their diet.
Stage 3 foods include those with a wider range of texture so babies about 9 months old can use their new teeth to chew.
Stage 4 foods are recommended for babies over 12 months of age and include more solid foods and table foods. After 12 months, if the baby is progressing normally, they can begin eating solids and foods that the rest of the family is eating.
There is nothing wrong with giving a baby cold formula or solids if he will take it. Some babies will refuse cold formula or solids but some prefer them cold.
New babies should be fed on demand, i.e. whenever they act hungry.
As far as solid foods are concerned, it seems to make little difference whether the baby is fed one, two or three times a day at first. As solids become more a part of the diet, you will want to work into a three-times-a-day schedule. Try to feed your baby when the rest of the family is eating so that he or she can be part of that daily social event and learn by observing as well.
It’s difficult to make specific recommendations as to what foods to serve at which meals. Most mothers give cereals in the morning and sometimes at night. Some give vegetables and meats at noon and some at night. In truth, it doesn’t seem to matter.
Toddler food is chunkier than strained food, but is not any more nutritious. Because of choking risks, don’t be in too big a hurry to start coarse foods like crackers, hot dogs, whole kernel corn and peanuts. There is no set age for introducing these foods. You just have to observe how well you child handles foods of increasing coarseness.
Yes, but you should consult with your pediatrician first.
Formulas are supplemented with all the vitamins a baby needs, and breast milk has enough of all the vitamins except vitamin D if the mother is receiving enough in her diet. We do recommend that breastfeeding moms continue to take their prenatal vitamins.
For a breastfed infant, a non-prescription vitamin D supplement is recommended until about 6 months old. After that, your doctor may talk to you about starting a multivitamin with fluoride.
At about age two a chewable tablet can be used if the child doesn’t eat fruits and vegetables well. The child that is a good eater and is offered a good variety of foods to eat doesn’t need extra vitamins.
After years of controversy, most scientists, the American Dental Association, the American Medical Association and the American Academy of Pediatrics have concluded that fluoride will significantly reduce the occurrence of cavities and is safe when given in the recommended amount.
It is true that large amounts of fluoride are toxic but so are large amounts of iron, vitamins D and A, calcium, salt and even water.
Fluoride is often included in vitamin preparations but can be given separately as drops or tablets with a proper prescription from your pediatrician.
Babies are born with enough iron stored in their bodies to last about three to four months. Iron deficiency may develop if iron-containing foods are not introduced at this time.
A child can be iron deficient without any of these signs, but general signs of iron deficiency include:
Iron deficiency in infancy has been linked to lower I.Q. scores and lower scores in school achievement tests later in life. Breast milk doesn’t have much iron in it, but what little iron is present is well absorbed. As a result, iron deficiency is uncommon in breastfed infants. Babies on formula should be given a formula with iron. Baby cereals, meats, and egg yolks are good sources of iron.
Many children have food allergies. In fact, most allergies that show up in the first six months of life are food allergies.
Common manifestations of food allergy include:
If a baby develops any of these symptoms, take him off the latest food you started him on. If the symptoms do not improve, please call your doctor. If your baby gets better you can retry the food to see if the same symptoms return.
This question has not been entirely answered yet. We are more aware of obesity in infants than ever before, but as yet do not know to what extent we should try to control it.
In general, one’s genetic makeup probably has more to do with whether one is obese than anything else. If both parents are obese the child has a high probability of being obese.
Certainly, overfeeding should be avoided. Some parents commonly give children food whenever they are in pain, frustrated or angry even though they are not hungry. Eating then becomes a means of dealing with stress and may play a part in adult obesity.
Your doctor will go over growth charts at each well visit. If there are any concerns, he or she will talk to you about them. This is a perfect time to discuss any issues you may have with your baby’s feeding habits or nutrition and come up with a plan together on how to address them.
Dr. Hershkop is a former New Yorker who really enjoys working with children from birth to age three, and is passionate about asthma, ADHD care, and dermatology. Languages: English, Hebrew
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