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.
Solid Foods (see also handout #16 Starting Solid Foods)
Breastfed babies normally do not require solid foods before 6 months of age. Indeed, many do not require solid foods until 9 months or more of age, if we can judge by their weight gain and iron status. However, there are some babies who will have great difficulty learning to accept solid food if not started before 7-9 months of age. Because the six month old baby will also soon need to have an additional source of iron, it is generally recommended and convenient that solids be introduced around 6 months of age. Some babies show great interest in grabbing food off the table by 5 months, and there is no reason not to allow them to start taking the food and playing with it and putting it in their mouths and eating it.
It has been the habit of physicians to suggest that babies be started first on cereals and then other foods be added. However, the 6 month old is far different from the 4 month old. Many 6 month old babies do not seem to like cereal if it is introduced at this time. Do not push the baby to take it, but offer other foods, and perhaps try again when your baby is a little older. But if he refuses, do not worry he will be missing something. There is nothing magic about cereal and babies do fine without it. Anyhow, your baby may soon be eating bread. The best way for the baby of getting additional iron is by eating meat.
There is no good reason why a baby needs to eat or be introduced to only one food per week, or why vegetables should be started before fruits. Anyone worried about the sweetness of fruit has not tasted breastmilk. The six month old can be given almost anything off his parents' plate that can be mashed with a fork.
Far fewer feeding problems will occur if a relaxed approach to feeding is taken.
Breastmilk, cow's milk, formula, outside work and bottles (see also handout #17 What to feed the baby when the mother is working outside the home)
A breastfeeding baby who is older than about 4 months will not likely take a bottle if he has not already gotten used to one. This is no loss or disadvantage. At about 6 months or even younger, the baby can start learning to use a cup, and usually will be quite good at drinking from a cup by about 7-8 months of age, if not sooner. If the mother is returning to paid work at about 6 months, there is also no need to start bottles or formula. In this situation, solids may be started somewhat earlier than 6 months of age (say 4 or 5 months of age), so that by the time the mother is working outside the home, the baby can be getting most of his food and liquid off a spoon when the mother is not with him. As he gets older, the cup may be used more and more for liquids. You and the baby can manage without his taking bottles. Do not try to starve the baby into taking a bottle if he refuses to accept one. Your baby is not being stubborn, but does not know how to use an artificial nipple. He also may not like the taste of formula, which is understandable.
Though there has been a lot of publicity recently about not giving babies cow's milk until at least 9 months, this does not really apply to breastfeeding babies. The breastfeeding baby can take some of his milk as cow's milk after about 6 months of age, especially if he is starting to take substantial amounts of a wide variety of solids as well. Goat's milk is an alternative. Many breastfeeding babies will not drink formula because they do not like the taste. Actually, the breastfeeding baby can get all the milk he needs from the breast without his requiring other sorts of milk, even if he is nursing only a few times a day.
My 4 month old is hungry on breast only. Solids or Formula?
There is no advantage in this situation of giving formula by bottle and there may be some disadvantage. Even at this age a baby may start to prefer the bottle if he seems not to getting enough from the breast (if, in fact, he will accept a bottle). It would be preferable in this circumstance to give solids off a spoon rather than to give formula in a bottle. (Frequently, however, this situation can be remedied differently by improving the breastfeeding-get help). If you wish to mix formula with solids, that does not cause the same sort of problem as giving it in a bottle. If the baby seems hungry after breastfeeding, feed him solids off a spoon. However, it may be possible with a simple techniques, to get the baby gaining well, and/or to be satisfied with breastfeeding alone. Check with the clinic.
Handout #10. Breastfeeding and Other Foods. Revised January 1998
Jack Newman, MD, FRCPC is a pediatrician, a graduate of the University of Toronto medical school. He started the first hospital-based breastfeeding clinic in Canada in 1984. He has been a consultant with UNICEF for the Baby Friendly Hospital Initiative in Africa. Dr. Newman has practiced as a physician in Canada, New Zealand, and South Africa.
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