by Dr. Jack Newman, MD
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 do not get the baby breastfeeding, then supplementation, if medically needed, can be given by 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.
by Dr. Jack Newman, MD
