Our providers strongly believe that the best way to nourish your baby is the way that works best for you, your baby, and your family. This may mean exclusive breastfeeding, exclusive formula feeding, or breast milk with formula supplementation. The most important focus is that babies are fed and nurtured in a healthy environment where they can grow and thrive.
The American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for 6 months, when possible. Breastfeeding can be continued, with the introduction of solid foods, until 1 year of age, or for as long as is mutually desired by mother and baby.
Often, breastfeeding can be difficult at first but progressively improves over the first few weeks after birth. Having short-term goals can be helpful so that you don’t feel that you are committing to a path that seems unsustainable in the long term. If you are having concerns or it is becoming too stressful, these goals can be reevaluated at home and with your pediatrician. Remember, both breastfed, and formula-fed babies grow up to be healthy children!
Introducing Solid Foods
- Allow 2-3 days for each new food before adding any additional new foods to monitor for reactions (such as hives, lip or tongue swelling, difficulty breathing, vomiting or diarrhea). This is most important with foods that commonly cause allergies (see below). You can be less cautious with common infant foods such as vegetables, fruits, and cereals, which rarely cause allergic reactions.
- For the same reason, begin with single foods before mixtures of foods so that it's easier to discern the cause if the baby has any form of adverse reaction.
- All solid food should be given by spoon, with the baby in an upright position.
Are there foods I should avoid?
- Children should not eat honey (or any foods containing honey, even when cooked) before 1 year of age. Honey can contain botulinum spores, which cause botulism.
- Avoid fish containing mercury, such as swordfish or tuna, as mercury can have negative effects on a child’s developing nervous system.
- Choking hazards should be strictly avoided (see section below for specifics).
- It is best to introduce whole cow’s milk after the age of 12 months. Milk proteins can be introduced earlier with yogurt, cheese, and other dairy products. For children under 12 months of age, drinking whole cow’s milk can contribute to low iron levels and may irritate the baby’s intestinal lining.
4- 6 months of age:
Children of this age are often beginning to demonstrate developmental readiness to start their adventure into solid foods. Some indicators that a baby is ready include good head control, sitting with some support, bringing hand to mouth, opening the mouth when a spoon comes near, making up and down movements with mouth, showing interest in the caregiver’s food, and closing the mouth if full and turning away.
It is recommended that infants who are exclusively breastfed start solids at 6 months, or earlier at 4-5 months if showing interest. Formula-fed babies may start as early as 4 months if developmentally ready.
Breast milk or formula will still be your child’s main source of nourishment. However, at this age, you may begin by introducing “Stage 1” foods, which are single ingredient, highly pureed foods of smooth texture and thin consistency, and can include vegetables, iron-fortified cereals, meats, and fruits. Little evidence exists in support of starting with one particular food over another. Your pediatrician may have specific preferences. If preparing purees at home, some families find it helpful to buy a jar or two of baby food to get a sense of the desired consistency.
As a general recommendation, start with 1-2 tablespoons of pureed food at 1 feeding per day for approximately 4 weeks, then twice a day for another 4 weeks, then three times a day, increasing the amount as your child seems interested. You may notice that the baby's need for breast milk or formula starts to decrease as solid food intake increases. This is normal and expected and not something to worry about. At meal-time, you might choose to offer breast milk or formula after the baby's solid food meal rather than before so that the baby will be more interested in the solids.
Directions for Mixing Infant Cereals:
When starting solids, infant cereals should be mixed with breastmilk, formula or water to a thin consistency, just thicker than breastmilk or formula. Either follow the instructions on the box or start with 1 teaspoon of cereal in 2 ounces of fluid. Increase the consistency over time as tolerated.
After 6 months:
When your baby is at least 6 months of age and has mastered eating thin purees, you can progress to “Stage 2” foods, which are thicker, single ingredient or simple combination foods.
Introducing Highly Allergenic Foods:
There is strong evidence that delaying the introduction of highly allergenic foods may result in an increase in the risk of food allergies. Once your baby has had a variety of foods and has demonstrated an ability to manage the textures, it is appropriate to try the potentially allergenic foods as early as 4-6 months of age. Try these foods one at a time, monitoring for hives or other signs of an allergic reaction:
- Milk proteins: whole milk yogurt or cheese (avoid large quantities of plain whole milk, which can lead to iron deficiency and other non-allergic problems)
- Egg: well-cooked scrambled eggs, mashed hard-boiled egg
- Peanuts/tree nuts: peanut or nut butter thinned with purees or breastmilk/formula, or peanut powder (available in the same aisle as peanut butter) mixed with purees or breastmilk/formula
- Fish: pureed low-mercury fish such as salmon or tilapia
- Shellfish: pureed low-mercury shellfish such as shrimp
- Wheat: infant whole-grain cereal
- Soy: pureed tofu
***Exceptions: If there is a strong family history of food allergy or the baby has a diagnosed food allergy or other allergic disease (such as severe eczema), you should discuss the introduction of these foods with your pediatrician first.
Introducing a Cup:
At 6 months of age, infants can start using a sippy cup to practice drinking. Sippy cups come in many different varieties but most infants do best with a straw cup or a “360” cup. Offer a few ounces of water (or breast milk or formula) with meals and snacks. We do not recommend giving juice to infants of any age.
8-9 months of age:
Once your baby has mastered pureed foods comfortably, has developed an immature grasp, and sits well without assistance, they are ready for ‘Stage 3’ foods, which are chunkier, textured, combination foods. This is also a great age to introduce soft finger foods, such as small pieces of whole-grain pasta, small shreds of cheese, soft fruits and veggies, small bits of meatball or soft-cooked chicken or fish, small pieces of whole grain muffins or pancakes, and many more. Babies can do some chewing even without teeth, but avoid large chunks or hard foods that require cutting, as these may be a choking hazard.
At this age you will continue to notice a decrease in the amount of breastmilk or formula consumed as your baby approaches one year. By age one year, most babies are taking 16-24 ounces of milk, down from about 32 ounces at 6 months of age.
Avoiding Choking Hazards:
Choking can occur when food (or other objects) block the airway and prevent an infant or child from coughing, crying and breathing. Common choking hazards to avoid until at least age 3-4 include:
- Hard candy
- Large pieces of meat
- Raw, hard fruits and veggies like carrots and apples
- Whole seeds and nuts
- Hot dogs
- Cherry tomatoes
- Large chunks of peanut butter or nut butter
Avoid choking hazards by cutting or shredding foods into thin strips (thinner than your child’s pinky finger) or small chunks (about the size of a pea). Nuts, popcorn and hard candy should be altogether avoided. Children should always be supervised while eating, should be sitting in their high chair at the table, and should never be running, playing or lying down while eating. If you believe your child is choking, it is always safest to call 911. We recommend all parents and caregivers take a CPR class to be prepared for these situations.
A quick word about pouches:
While we appreciate the convenience that pouches provide, we feel they should be used sparingly, if at all. Pouches do not support healthy oromotor development, encourage infants to “drink” their food and thus eat too quickly, and produce significant amounts of environmental waste. If you do choose to give your child pouches, we encourage you to serve them from a bowl with a spoon.
After 12 months of age:
Introducing Cow’s Milk:
The transition from breastfeeding or formula to whole cow's milk can happen at any time after 12 months of age. We often suggest trying out cow's milk on its own. If your child enjoys and accepts it, then you have made an easy transition! If he/she rejects it, you can mix breast milk/formula with cow's milk and slowly start increasing the amount of cow's milk as the child adjusts to the flavor.
As your child is now eating plenty of solid foods, milk is no longer providing the majority of nutrients in the diet, but it is still a valuable source of protein, fat, calcium, vitamins and minerals. For now, whole milk (rather than skim, 1% or 2%) is a good choice as dietary fat is important for brain development. We recommend avoiding excessive amounts of whole milk (more than about 20-24 ounces per day) as this can contribute to low iron levels and anemia, as well as cause toddlers, to fill up on calories from just one food source.
Self-care for Mother
Breastfeeding mothers need extra calories to maintain their own well-being and to generate nutrition for their babies. Mothers should eat three well-balanced meals as well as nutritious snacks every day. 500 extra calories per day are recommended for breastfeeding. The fat accumulation from pregnancy is also available as a ready supply of calories. When your diet is inadequate you may feel fatigued or listless and may lose weight. Eventually, prolonged intake of an inadequate, diet may lead to a decrease in the quantity of milk produced. Food selections need to be made from all food groups. You do not need to eliminate any specific food from your diet, even spicy or gassy foods. The only foods that may be restricted are those that the baby is allergic to, since proteins can pass through to breast milk. Speak with your pediatrician if you have concern for allergies.
A nursing mother is encouraged to drink to thirst to meet her own fluid requirements. One easy way to ensure adequate fluid intake is to have something to drink when you sit down to nurse your baby. Water, juice and milk are good choices; limit "empty calorie" fluids or caffeinated beverages.
- No soap, creams, or oils necessary. Normal showering.
- For sore nipples, Lasinoh and PureLan cream are safe to use. No need to remove cream prior to nursing baby.
- Any cracks or bleeding, please call an LC or other Health care professional.
Get Plenty of Rest:
Although the birth of your baby is a joyful experience, it is also exhausting. The unrelenting needs of a newborn leave you short-changed on sleep. Take naps and eat well-balanced meals. Keep company to a minimum for a while and relax housekeeping standards temporarily. Have friends and family help you during this time.
Caffeine: Moderation is advised. Coffee has the most caffeine. The recommended amount is no more than 2 - 3 cups/day (i.e., no more than 25 oz/day). Excess caffeine may lead to hyperactivity or excess wakefulness in the infant. Decaffeinated products are safe to use.
Exercise: Regular exercise is healthy during lactation and does not interfere with milk supply. The taste of breast milk may change after strenuous exercise (exercising to exhaustion) due to the build up of lactic acid. Try to feed your baby before you work out to make exercise more comfortable. Wear a well supportive bra while you exercise.
Medication: Prescription and over-the-counter medications can pass through breast milk to your baby. Fortunately, in most cases the amounts are minimal and cause no harm to the baby. However, it is important to check with your doctor or pediatrician before taking any medication.
Alcohol: Alcohol passes into breast milk and affects the central nervous system of the mother and baby. Effects may include sedation, irritability, and weak suck; you may also notice a decrease in milk supply. The baby’s gross motor development may be delayed and is directly related to the quantity that the mother ingests. On special occasions, a small glass of wine or beer is acceptable. The mother should breastfeed the baby prior to having an alcoholic drink, then wait 2 – 3 hours per drink before breastfeeding the baby again. It is best to avoid alcohol altogether if possible.
Tobacco: Cigarettes can lead to relatively high levels of fat-soluble nicotine in breast milk. It can decrease a mother's milk secretion or inhibit letdown reflex if the mother smokes immediately before nursing. Mothers who smoke need twice the normal intake of vitamin C because smoking affects the body's ability to utilize this vitamin. Exposing the baby to smoking can lead to increased illness (this is known as risks of passive smoking).
Hair Dye: Dyeing the hair is permissible okay every few months. It is suggested that the dye/color not be directly applied to the scalp to minimize systemic absorption, which could lead to some inclusion of the dye chemicals in breast milk.
Signs of Good Milk Intake:
- Breastfeeding at least 8-12 times/day. Baby may also cluster feed (short frequent feedings, then a longer stretch to next feeding).
- Breasts let down (leak) in one breast while nursing on the other. (Not everyone leaks)
- Breasts feel full before nursing and softer after nursing. Mom feels a tugging on her nipple.
- Baby has a good latch, sucks well and you can hear baby swallow, 1:1 ratio of sucking and swallowing.
- Healthy skin tone and color (baby).
- 6-8 wet diapers/day – pale yellow urine.
- Stools change from thick almost black to thinner brown to yellow, mustard seedy stools. (average 4/day)
- Regular intervals of wakefulness, sleep and feeding. Baby seems content between feeds.
- Fat increases in arms and legs.
- Adequate weight gain as per your pediatrician. Average is 3⁄4 - 1 oz per day in the first several months.
Growth Spurt - Increase in Nursing Frequency:
You may notice an increase in the frequency with which your baby nurses. All babies go through periods of sudden growth during their early months. These periods usually last only a few days. The most common periods are: first few days home; 10-14 days, 4-6 weeks, 3-6 months; other periods - time of illness, over stimulation, emotional upset, or physical discomfort.
Correct positioning (this includes most common positions: cross cradle, football/upright and lying down):
- Mom should be in a comfortable position, using pillows to support mother’s arms, back and lap. Elevate feet on a small stool.
- Baby should be positioned so baby can latch the areola. Make sure mom's fingers are not on the areola to prevent latching onto the nipple only. Align baby nose to nipple.
- Keep baby's head at breast level and do not lean over to reach baby.
- Infant should be close to mom so tip of baby's nose and chin touch the breast.
- Baby's mouth should be opened wide and positioned slightly below center of the breast. This will result in baby's lower lip covering more of the lower areola than the upper areola, asymmetrical latch.
- Baby's tongue should be flanged out and extend over his/her lower gum.
- Baby's ear, shoulder and hip should be in a straight line facing its mother, tummy to tummy.
- To release the baby's mouth from your breast, insert your finger between baby's lips to break the suction
Mom Returning to Work
It is up to you when you return to work. If you have questions about coordinating work with breastfeeding, feel free to call our office so we can help you with this transition. Many of our mothers have success returning to work and continuing to breastfeed; it is possible!