Houston, Texas, USA: It is World Breastfeeding Week. Breastfeeding provides an infant with essential calories, vitamins, minerals, and other nutrients for optimal growth, health, and development. Breastfeeding is beneficial to both a mother and her infant and also offers an important opportunity for the pair to bond.
The National Institute of Child Health and Human Development (NICHD) supports many areas of breastfeeding research, including studies of the benefits of breastfeeding and breast milk, the social and cultural impacts of breastfeeding, and the nutritional components and mechanisms of disease related to breastfeeding and breast milk.
Here are parts of the NICHD of the National Institutes of Health (NIH) guidance on breastfeeding – edited by Nigeria Circle News.
Breastfeeding and Breast Milk
Breastfeeding, also called nursing, is the process of feeding a mother’s breast milk to her infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant. Breastfeeding and breast milk provide an infant with calories and nutrients, including macronutrients (fat, protein, and carbohydrates) and micronutrients (vitamins and minerals).1
According to the American Academy of Pediatrics (AAP) Policy Statement on Breastfeeding, women who don’t have health problems should exclusively breastfeed their infants for at least the first 6 months after birth.
The AAP suggests that, if possible, a woman should try to continue breastfeeding her infant for up to 12 months, while adding other foods, because of the benefits to both the mother and the infant.
Although breastfeeding is the recommended method for feeding infants, and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D3. The current recommended daily vitamin D intake for infants and children is available on the American Academy of Pediatrics website
Benefits of breastfeeding
Research shows that breastfeeding offers many health benefits for infants and mothers, as well as potential economic and environmental benefits for communities.
Breastfeeding provides essential nutrition. Among its other known health benefits are some protection against common childhood infections and better survival during a baby’s first year, including a lower risk of Sudden Infant Death Syndrome.
Research also shows that very early skin-to-skin contact and suckling may have physical and emotional benefits.
Other studies suggest that breastfeeding may reduce the risk for certain allergic diseases, asthma, obesity, and type 2 diabetes. It also may help improve an infant’s cognitive development. However, more research is needed to confirm these findings.
Recommendations for breastfeeding
In the United States, the American Academy of Pediatrics (AAP) currently recommends:
- Infants should be fed breast milk exclusively for the first 6 months after birth. Exclusive breastfeeding means that the infant does not receive any additional foods (except vitamin D) or fluids unless medically recommended.
- After the first 6 months and until the infant is 1 year old, the AAP recommends that the mother continue breastfeeding while gradually introducing solid foods into the infant’s diet.
- After 1 year, breastfeeding can be continued if mutually desired by the mother and her infant.
The World Health Organization currently promotes as a global public health recommendation that:
- Infants be exclusively breastfed for the first 6 months after birth to achieve optimal growth, development, and health.
- After the first 6 months, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond.
According to the Centers for Disease Control and Prevention, the majority of new mothers start out breastfeeding, but only a minority still exclusively breastfeed by the time their infants are 6 months old. Many factors influence successful breastfeeding, including support from health care providers, family and community, and the workplace.3
The 2011 Surgeon General’s Call to Action to Support Breastfeeding makes 20 recommendations to support new mothers in their decision to breastfeed.
Weaning and how to do it
Weaning is the process of switching an infant’s diet from breast milk or formula to other foods and fluids. In most cases, choosing when to wean is a personal decision. It might be influenced by a return to work, the mother’s or infant’s health, or just a feeling that the time is right.
Weaning an infant is a gradual process. The American Academy of Pediatrics (AAP) recommends feeding infants only breast milk for the first 6 months after birth. After 6 months, the AAP recommends a combination of solid foods and breast milk until the infant is at least 1 year old. The Academy advises against giving cow’s milk to children younger than 1 year old.3
You may have difficulty determining how much to feed your child and when to start introducing solid foods. The general guidance below, as reported by the National Library of Medicine, demonstrates the process of weaning for infants up to 6 months of age.4 You should speak with your infant’s health care provider before attempting to wean your infant to make sure that he or she is ready for weaning and for complete guidance on weaning.
- Birth to 4 months of age
- During the first 4 to 6 months, infants need only breast milk or formula to meet their nutritional needs.
- If breastfeeding, a newborn may need to nurse eight to 12 times per day. By 4 months of age, an infant may need to nurse only four to six times per day.
- By comparison, formula-fed infants may need to be fed about six to eight times per day, with newborns consuming about 2 to 3 ounces per feeding. The number of feedings will decrease as the infant gets older, similar to breastfeeding.
- During the first 4 to 6 months, infants need only breast milk or formula to meet their nutritional needs.
- 4 to 6 months of age
- At 4 to 6 months of age, an infant needs to consume 28 to 45 ounces of breast milk or formula per day and often is ready to start being introduced to solid food.
- Starting solid foods too soon can be hazardous, so an infant should not be fed solid food until he or she is physically ready.
- Start solid feedings (1 or 2 tablespoons) of iron-fortified infant rice cereal mixed with breast milk or formula, stirred to a thin consistency.
- Once the infant is eating rice cereal regularly, you may introduce other iron-fortified instant cereals.
- Only introduce one new cereal per week so that intolerance or possible allergies can be monitored.
Special conditions or situations in which you should not breastfeed
in special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply.
Medications/Other Drugs and Breastfeeding
Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should speak with their health care providers before considering breastfeeding:
- Antiretroviral medications (for HIV/AIDS treatment)
- Birth-control medications containing estrogen, until breastfeeding has been well established
- Cancer chemotherapy agents
- Illegal drugs
- Certain medications prescribed to treat migraines, such as ergot alkaloids
- Mood stabilizers, such as lithium and lamotrigine
- Sleep-aid medicines
- In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding.
The above list of medications and other drugs is only a guideline. Before breastfeeding, you should speak with your health care provider about all medications that you are taking. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.
Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed.5
Contact your infant’s health care provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness.
Health Conditions and Breastfeeding
Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.
If you have any of the following conditions, breastfeeding your infant is NOT advised. For more information, speak with your health care provider:
- Infection with HIV
- Infection with human T-cell lymphotropic virus type I or type II
- Untreated, active tuberculosis
- If you are sick with the flu, including the H1N1 flu (also called the swine flu), you should not stop feeding your infant expressed milk. You should avoid being near your infant, however, so that you do not infect him or her. To avoid infecting your infant, someone who is not sick should give your infant your expressed milk.
If you have Zika virus or live in areas where Zika virus is found, the CDC recommends you continue to breastfeed your infant. Although Zika virus has been detected in breast milk, there are no reports of transmission of the virus through breastfeeding, and the benefits of breastfeeding are thought to outweigh the risks.
Domestic and International Guidelines on HIV/AIDS and Breastfeeding
In the United States, the American Academy of Pediatrics and the CDC recommend against breastfeeding if you are HIV positive; the same advice applies in other developed countries. Without any specific interventions to reduce transmission, infants breastfed by HIV-positive mothers have an increased chance of acquiring HIV through the breast milk. This rate increases if infants are breastfed longer and for mothers with newly-acquired HIV.
Only HIV-positive mothers living in developing countries should consider breastfeeding their babies, especially if a safe and reliable source of infant formula is unavailable.9 This is because breast milk may protect against malnutrition and diarrhea, which are major causes of infant mortality in some areas of the developing world. If an HIV-positive woman decides to breastfeed her baby, research indicates that the risk of transmitting HIV to her baby is reduced if she exclusively breastfeeds (does not use a combination of formula and breast milk) and if she and her infant take antiretroviral drugs.
Other Considerations for Breastfeeding
In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding.
- Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes should monitor their blood sugar levels regularly, may need to reduce their insulin, and may need a snack containing carbohydrates before or during breastfeeding.12 Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding.
- Women who have had breast surgery in the past may face some difficulties with breastfeeding.
- Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed.
- Infants who have galactosemia—a rare metabolic disorder in which the body cannot digest the sugar galactose—should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.
Do breastfed infants need other nutrition?
Vitamin D supplementation for infants
Although breastfeeding is the recommended method for feeding infants and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D. Vitamin D is required to prevent rickets, a type of vitamin D deficiency. This disease is rare among breastfed infants but can occur if vitamin supplementation or exposure to sunlight is inadequate. (Exposure to sunlight helps the body to make vitamin D in place of supplementation.)
The current American Academy of Pediatrics (AAP)–recommended daily vitamin D intake is 400 IU per day for all infants and children beginning from the first few days after birth.2 Human breast milk contains a vitamin D concentration of 25 IU per liter (about 4 cups) or less. Therefore, to meet the 400 IU daily requirement, supplementation is required.
If an infant is weaned to a vitamin D-fortified infant formula and consumes at least 4 cups per day, then additional supplementation with vitamin D is not necessary.
When to Supplement Breastfeeding
Breastfeeding is supplemented by feeding an infant expressed breast milk from a bottle, formula, or breast milk from another mother. Such supplementation may be needed in the following situations:
In the Mother:
- Breast surgery or other trauma
- Primary breast insufficiency that prevents adequate milk production
- Physical separation from the infant
- Serious illness
In the Infant:
- Weight gain insufficient to maintain health (also sometimes called failure to thrive)
- Cleft lip and/or palate or other abnormality that prevents normal suckling ability
- Jaundice or liver problems
- Serious illness or prematurity that requires the infant to be cared for in a special nursery
Many of these conditions require a health care provider’s care. You should always talk with your child’s health care provider about whether to supplement your breastfeeding.
To keep supplementation from shortening or otherwise interfering with breastfeeding, you should supplement only after your infant is breastfeeding effectively and thriving on your breast milk.
Mixing Formula with Breast Milk
Mixing formula with breast milk in the same container is one way of supplementing breast milk. You may want to supplement your breast milk with infant formula if your milk supply is low or when you are physically separated from your infant.
Supplementing your breast milk with formula, however, may not be nutritionally the same as giving breast milk. Discuss the practice with your infant’s health care provider before starting to mix formula with your breast milk.
The term “complementary feeding” refers to giving your baby solid and liquid foods other than breast milk or infant formula. As babies grow, they have nutritional needs that breast milk or infant formula alone cannot meet. Complementary feeding helps meet those nutritional needs. It is also important for infants’ jaw and muscle development and helps them develop speech later.5
The AAP and the World Health Organization (WHO) recommend introducing safe, nutritious complementary foods into your infant’s diet around 6 months of age.4,6 The exact timing depends on the infant’s developmental readiness, meaning whether the baby can open his or her mouth and lean forward when interested in food. Studies show that introducing complementary foods before 4 months offers little health benefit to the infant and can increase the risk of food allergies and choking.5
Some complementary foods are often called “baby foods” and can be pureed or mashed-up versions of meats, fruits, and vegetables. Different foods offer different nutrients. For example, around 4 to 6 months of age, babies’ iron and zinc needs are higher than what breast milk or infant formula alone can provide. Complementary feeding of fortified cereals or pureed meats can provide these nutrients.
If you have any questions about complementary feeding, or if your family has a history of food allergies, talk to your infant’s health care provider.