By Jessie Funchion, MS, RD, LDN
1) How long is it recommended to breastfeed?
6 months exclusive breastfeeding (according to AAP/WHO/AND), and ideally longer with complementary foods. The AAP recommends at least 1 year and the WHO recommends at least 2 years.
2) How long does a feeding session take? How much milk is the baby getting?
At first, probably each feeding will likely take 30-45 minutes and should occur every 2-3 hours, or on demand. From 0-6 months, the infant will likely get around 25-30oz a day, for a total of 400-600 calories.
3) What are contraindications to breastfeeding?
– Are HIV positive in the U.S.
– Have untreated brucellosis
– Have Human T-cell lymphotrophic virus type I or II or use street drugs
– Use street drugs
Infants who have galactosemia, an inborn error of metabolism that is diagnosed first few days of life, also should not breastfeed.
If mothers have hepatitis C or are hepatitis B surface antigen positive, have a fever or take certain medications (See LactMed) or have exposure to low level environmental chemicals, they can still breastfeed! If the baby has jaundice, they can also still breastfeed (it may even help). Occasional alcohol or cigarette use is also compatible with breastfeeding, though not encouraged.
4) What is breast milk composed of?
Breast milk composition changes over the course of the baby’s life, as well as over the course of a feeding. Colostrum is rich in protein and fat soluble vitamins and produced in very small amounts (only 1 tsp/feeding). Mature milk is actually 90% water and 10% macros, and is around 20 calories per ounce. The macronutrient composition is mostly carbohydrate (lactose), low protein (7-8%) and the fat content is variable.
Breast milk also contains a ton of ‘non-nutritive’ substances such as immune factors, appetite regulating hormones and prebiotics.
5) What are the benefits of breastfeeding for babies?
Breastfed infants have lower rates of gastrointestinal and respiratory infections, ear infections, necrotizing enterocolitis and SIDS. There is also correlation between breastfeeding and lower risk of chronic disease such as type 1 diabetes, Celiac disease, obesity, asthma, dermatitis and leukemia, but more research is needed.
6) What are the benefits of breastfeeding for moms?
Women who breastfeed have a lower risk of hemorrhage after birth, post-partum depression and premature return of ovulation. There is correlation between nursing and body weight/weight retention, type 2 diabetes, cancer (breast/ovarian), heart disease and hypertension, but again, more research is needed.
7) What supplements should mom and baby take?
It’s not a bad idea for women to continue taking a prenatal vitamin while nursing, but the biggest nutrients of concern are Calcium, Vitamin D and Iron. Exclusively breastfed babies should receive 400IU Vitamin D each day.
8) When should complementary foods be introduced?
Generally 6 months of age. Some signs that infants are ready for food are…
– sitting up on his own
– reaching for a spoon
– not spitting up food
– growing teeth
It’s recommended to start with iron and zinc rich foods such as dark leafy greens, meat, fish or iron-fortified cereals.
9) How do I know the baby is getting enough milk?
– GROWTH: The infant should be progressing appropriately along his or her growth curve
– DIAPERS: 1 dirty/1 wet on day 1 of life, 2 dirty/2 wet on day 2, etc., until infant produces around 3-4 dirty diapers each day and 5-6 wet diapers each day.
– BEHAVIOR: Infants should appear somewhat relaxed and satiated after a feeding
10) What should mom include in diet? Avoid in diet?
Women’s diets should look pretty similar to their third trimester diets, about 400-500 extra calories a day. Focus on a well balanced diet that includes all 5 food groups. Women should drink to thirst, but aim for 3L total fluids each day.
Limit caffeine to 300mg/day and seafood to 12oz/week. Alcohol can be enjoyed in moderation, but keep in mind alcohol in milk peaks about 30-90 minutes after consumption.
And remember, while ‘breast is best’, we’re very lucky in this country to have formula as an excellent back up plan!
Source: DietitianCentral.com, “Nutrition During Lactation: The First Year and Beyond”