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This
is not an information
sheet on all the ins and outs of working outside the home and
breastfeeding. This sheet provides information on how your baby
can be fed when you are not with him. It is addressed in
particular to the mother who is returning to paid work when the
baby is about 6 months of age. New mothers should stay home with
their babies for as long as practical and take full
advantage of the 52 weeks maternity leave to which mothers have
a right in Canada. If
you cannot take a full year, take at least 6 months, better 7
months (from the point of view of ease of continuing
breastfeeding while away from your baby). Your baby will never
be this age again.
Some
Myths:
1.
Babies must learn to take a bottle so that they can be fed when
the mother is not there.
Not
true. Some exclusively breastfed babies will not take a bottle
by 2 or 3 months of age. Most, who have not taken a bottle, and
even some who did accept a bottle in the first weeks of life
will not take one by the time they are 4 or 5 months of age. This
is no tragedy, and there is no reason to give a bottle early
so that the baby knows how. If your baby is refusing to take a
bottle, do not try to force him; you and he may become very
frustrated and there is
just no need to go
through all this. If the baby is at least 6 months of age
when you start back at outside work, the baby quite simply does
not need to take a bottle. If he is even 4 months, he does
not need to take a bottle. He can be fed liquids or solids off a
spoon just as any other 6 month old and by 6 months of age he
can be taking enough so that he will not be hungry during the
day. Furthermore, he can start learning to drink from a cup even
by 5 or 6 months of age. The cup can be an open cup and does not
need to have a spout. Start with water as your baby may spill a
fair amount at first. If, however, he has not got the hang of
the cup by the time you must leave him, do not worry, he can
take fluids off a spoon, or the solid foods can be mixed with
more liquid (expressed milk, juice, water). Obviously, if the
baby is to be taking a fair amount of a variety of foods by 6
months of age, he may need to be started on solids by 5 months
of age. However, some babies prefer to wait for the mother in
order to drink something. This is fine; many babies sleep 12
hours at night without drinking or eating at all.
2.
But getting the baby to take a bottle surely won’t hurt.
Not
necessarily true. Some babies do fine with both. The occasional
bottle, when breastfeeding is going well, will not hurt. But if
the baby is getting several bottles a day on a regular basis,
and, in addition, your milk supply decreases because the baby is
nursing less, it is quite possible that the baby will start
refusing the breast, even if he is older than 6 months of age.
3.
Babies need to drink milk when the mother is not at home.
Not
true. Three or four good nursings during a 24 hour period plus a
variety of solid foods gives the baby all he needs
nutritionally, and thus he does not
need any other type of milk when you are at your outside job. Of
course, solid foods can be mixed with expressed milk or other
milk, but this is not necessary.
4.
If the baby is to get milk other than breastmilk, it needs to be
artificial baby milk (infant formula) until the baby is at least
9 months of age.
Not
true. If the baby is breastfeeding a few times a day and getting
fair quantities of a variety of solid foods, infant formula is
neither necessary nor desirable. Indeed, babies who have not had infant
formula before 5 or 6 months of age often refuse to drink it
because it tastes pretty bad. (If you want to convince yourself
of how little we know about breastmilk, ask yourself why it is
that, although breastmilk and infant formulas have the same
amount of sugar, breastmilk is so much sweeter). If you want to
give the baby some other sort of milk, homogenized milk is
acceptable at 6 months of age, as long as it is not the baby’s
only food. In fact, if the baby is taking good quantities of a
wide variety of foods, breastfeeding 3 or 4 times a day, and
growing well, homogenized milk or 2% milk is good enough, but
also not necessary.
5.
Babies need to drink milk to get calcium.
Not
true. If you are
worried about the baby’s intake of calcium, he can eat cheese
or yogurt. There is
no need to drink the calcium. Besides, if the baby is also breastfeeding, breastmilk still
contains calcium.
6.
Followup formulas (artificial milk for infants over 6 months of
age) are specially adapted to the needs of infants 6 to 12
months of age.
Not
true. They are completely unnecessary and are specially adapted
to the needs of the formula companies’ profit margins. They
also are part of a marketing strategy that tries to get around
restrictions on the advertising of artificial baby milks
directly to the public (widely disregarded in any case). In
Europe now, there are special formulas available for the toddler
(1-3 years of age). Some people will buy anything, it seems. But
these toddler formulas will soon be here. You can bet on it.
Bottom line über alles.
We will all soon be on formula from birth to death.
7.
The breastfed baby 4 months of age needs to be getting more iron
than can be provided by breastmilk alone.
Not
true. For the baby born at term who is breastfeeding
exclusively, all the iron required is provided by breastmilk.
However, by 6 months of age, more or less, it is prudent for the
baby to begin getting
more iron than that provided by breastmilk alone. The best way for your baby to get iron is through his food,
and the best source of iron is meat, not formula, and not infant
cereals.
8.
The best way to assure the baby’s getting enough iron is to
give him infant cereals.
Not
true. Infant cereals do contain a lot of iron, but most of it is
not absorbed, and this amount of iron seems to cause
constipation in some babies. Furthermore, some breastfed babies
who have had only breastmilk to 5 or 6 months of age do not like
cereal. There is nothing wrong with infant cereal, but pushing
this food on reluctant babies may result in later feeding
problems. The best way to ensure the baby is getting enough iron
is to continue breastfeeding, and introduce solid foods in a
relaxed, enjoyable way at the appropriate time (See handout #16 Starting
Solid Foods). The appropriate time is when the baby is
showing interest in eating by reaching out for and trying to eat
food the parents or other members of the family are eating. This
occurs usually about 4 1/2 to 5 1/2 months of age. A baby this
age can eat what the parents eat, with few exceptions. There is
no need to be obsessive about the order in which foods are
introduced, or trying to keep the baby eating only one
food/week. The easiest way to give extra iron for the 6 to 12
month old baby is meat, the iron of which is very well absorbed.
Start feeding the baby solids in a way that makes eating
enjoyable, and the baby will eat iron containing foods just
fine.
Questions?
(416) 813-5757 (option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide to Breastfeeding (called
The Ultimate Breastfeeding Book of Answers in the USA)
Handout
#17 What to Feed... Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further
permission,
on the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated.
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