Infant Nutrition: Breastfeeding & Introducing Solid Foods to Your Baby

Lisette T. Jacobson, PhD, MPA, MA; Assistant Professor, Research, University of Kansas School of Medicine-Wichita

Pamela Behrman, PhD; Professor of Psychology, College of Mount Saint Vincent

Helena Laroche, MD; Assistant Professor of Internal Medicine, University of Iowa

Danielle M. Wischenka, PhD; Behavioral Medicine Psychology Postdoctoral Fellow, VA Palo Alto Healthcare System

Jolynn Dowling, MSN, APRN, NNP-BC, IBCLC, Associate Educator, Janice M. Riordan Distinguished Professorship in Maternal Child Health, Wichita State University
 

Evidence suggests that breastfeeding is associated with positive health benefits. Human milk provides infants with protection from infections during the first year of life, and is associated with decreased risks of infant death and sudden infant death syndrome. Breastfeeding also provides some protection from chronic diseases such as asthma, diabetes mellitus, and obesity during childhood and adolescence. Mothers appear to benefit from breastfeeding as well, with reduced risk of breast cancer, ovarian cancer, type 2 diabetes, cardiovascular disease, and stroke.

It is often said that, in infant feeding, "breast is best." Yet, despite documented health benefits, the Centers for Disease Control and Prevention report only 58% of U.S. mothers breastfeed their baby at six months of age and only 36% breastfeed at 12 months, even though a large number of mothers (83%) start breastfeeding soon after birth. Exclusive breastfeeding rates are even lower: 47% of mothers exclusively breastfeed at three months and 25% exclusively breastfeed at six months. The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for six months so that the health benefits of breastfeeding for mother and infant are optimized.

Mothers do not breastfeed for as long as they intend to due to issues with lactation (i.e., producing milk) and latching of the baby onto the breast, concerns about infant nutrition and weight, concerns about taking medications while breastfeeding, lack of parental leave, cultural norms, lack of family support, and unsupportive hospital practices and policies.

Common breastfeeding concerns and where to get answers:

1. “Breastfeeding hurts.” With proper guidance, pain should be minimal. However, if you are having pain with breastfeeding, please seek out your professional lactation consultant, pediatrician, or gynecologist.
    
2. “I can’t breastfeed for the whole six months.” Even if you only breastfeed for a few days, you have still provided important infection protection and nutrition to your baby. Breastfeed for as long as you can to meet your own breastfeeding goals, but any period of time helps your baby and you!
    
3. “Mom says I did just fine on formula.” Yes, you did but there are important nutrients in breast milk that formula just cannot copy. Besides, breast milk is cheaper!
    
4. “My baby will not gain enough weight.” Most babies lose weight during the first week (as they are supposed to) and then gain weight. Work with your professional lactation consultant or doctor to monitor your baby’s weight and you can make sure he or she is doing fine.
    

Where can you get help?

Organizations at the national, state, and local level advocate for and implement initiatives to change the culture of breastfeeding so that all mothers and children will have an increased opportunity to meet public health goals. Groups such as those below offer support, information, and community resources for breastfeeding families: 

1. Finding breastfeeding support and information:
   https://www.womenshealth.gov/breastfeeding/learning-breastfeed/finding-breastfeeding-support-and-information
    
2. American Academy of Pediatrics:
   https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/default.aspx
    
3. About Breastfeeding:
   https://www.cdc.gov/breastfeeding/
   https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/what-to-expect.html
    
4. La Leche League
    
5. March of Dimes
    
6. United States Breastfeeding Committee
    
7. Information about medication safety during pregnancy and lactation can be found at:
   https://www.infantrisk.com/
   https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
   http://mommymeds.com/home
    
8. Information for women of color and their families can be found at:
   https://www.womenshealth.gov/its-only-natural
   http://www.napplsc.org/
   http://itcaonline.com/wp-content/uploads/2011/10/breastfeedingguide-nativeamerican-english.pdf
   https://salud-america.org/latina-mom-baby-health-research-breastfeeding/
    
9. Information on breastfeeding coalitions in states and U.S. territories can be found at:
   http://www.usbreastfeeding.org/coalitions-directory
    
10. Many hospitals have lactation consultants on staff. Ask your doctor, gynecologist, or pediatrician for help connecting with a lactation consultant who can help you and your baby learn how to breastfeed.

Breastfeeding families, caregivers, and providers should check with their state or local breastfeeding coalition for additional resources regarding breastfeeding clinics, hospital initiatives, worksite accommodations, and peer and professional breastfeeding support.
 

Tips for introducing foods to infants

1. Pediatricians do not recommend starting solid food until around 6 months of age (4 months minimum).
    
2. It does not matter which solid food you start with. By tradition, single-grain cereals are usually introduced first. However, there is no medical evidence that starting solid foods in any particular order has an advantage for your baby. Give your baby one new food at a time. Generally, meats and vegetables contain more nutrients per serving than fruits or cereals.
    
3. Babies or young children rarely eat something the first time it is given to them. They may even spit it out at you. Come back to it and try again. Children may need to be exposed to a food item 10 to 15 times before they will eat it. Offering your child one taste before allowing him or her to refuse a dish adds up toward the desired result. “No” does not mean they will never eat it, just not this time.
    
4. You provide, they decide. Your job is to provide them with a variety of foods, especially healthy foods. Their job is to pick from among those healthy foods which to eat and how much.
    
5. Remember that child portions are much smaller than adult portions.
    
6. Try not to bribe children with food – especially sweet food. Use non-food rewards – stickers, hugs, playing their favorite games.
    

Check out these websites for more information of introducing foods to children:

1. https://www.ellynsatterinstitute.org/
2. https://www.healthychildren.org/English/Pages/default.aspx

 

References

Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding – Systematic reviews and meta-analyses. 2007.

Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment. 2007(153):1-186.

American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-841.

Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1):e18-25.

Heinig MJ. Host defense benefits of breastfeeding for the infant. Effect of breastfeeding duration and exclusivity. Pediatr Clin North Am. 2001;48(1):105-123, ix.

Ladomenou F, Moschandreas J, Kafatos A, Tselentis Y, Galanakis E. Protective effect of exclusive breastfeeding against infections during infancy: A prospective study. Arch Dis Child. 2010;95(12):1004-1008.

Huffman SL, Zehner ER, Victora C. Can improvements in breast-feeding practices reduce neonatal mortality in developing countries? Midwifery. 2001;17(2):80-92.

McVea KL, Turner PD, Peppler DK. The role of breastfeeding in sudden infant death syndrome. J Hum Lact. 2000;16(1):13-20.

Vennemann MM, Bajanowski T, Brinkmann B, et al. Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics. 2009;123(3):e406-410.

Gerstein HC. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes care. 1994;17(1):13-19.

Bernier MO, Plu-Bureau G, Bossard N, Ayzac L, Thalabard JC. Breastfeeding and risk of breast cancer: A meta-analysis of published studies. Hum Reprod Update. 2000;6(4):374-386.

Danforth KN, Tworoger SS, Hecht JL, Rosner BA, Colditz GA, Hankinson SE. Breastfeeding and risk of ovarian cancer in two prospective cohorts. Cancer Causes Control. 2007;18(5):517-523.

Jordan SJ, Cushing-Haugen KL, Wicklund KG, Doherty JA, Rossing MA. Breast-feeding and risk of epithelial ovarian cancer. Cancer Causes Control. 2012;23(6):919-927.

Schwarz EB, Brown JS, Creasman JM, et al. Lactation and maternal risk of type 2 diabetes: a population-based study. Am J Med. 2010;123(9):863 e861-866.

Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005;294(20):2601-2610.

Centers for Disease Control and Prevention. Breastfeeding. https://www.cdc.gov/breastfeeding/data/facts.html. Accessed July 16, 2018.

La Leche League (N.D.) About us. Retrieved https://www.lllusa.org/about-us/

March of Dimes (N.D.) Breastfeeding help. Retrieved https://www.marchofdimes.org/baby/breastfeeding-help.aspx

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