If you eat a well-balanced healthy diet, there is little need to take a supplement to meet your nutrient needs for breastfeeding. However, there are circumstances when it might be a good idea:
• You find it difficult to make healthy food choices.
• You are a complete vegetarian (vegan) and you don’t use vitamin B12-fortified foods like soy and rice beverages.
• You’re concerned about meeting your iron needs because you eat very little red meat and don’t choose whole grains very often.
• You avoid dairy products and don’t choose calcium-fortified products such as soy and rice beverages or orange juice.
• You’re at risk for vitamin D deficiency because you spend very little time in the sun and you don’t drink milk or fortified soy/rice milk.
A good quality multivitamin and mineral supplement will help you meet your nutrient needs, with the exception of calcium, during and after breastfeeding. If you are lacking calcium in your diet, I recommend that you take calcium supplements. For every serving of milk or milk alternative you don’t get—aim for three a day— take a 300-milligram calcium citrate supplement with vitamin D added. Do not take high-dose single supplements of other nutrients while breastfeeding. Make an effort to choose nutritious, wholesome foods every day.
Weaning to Solids
Nutritionally, your baby will not need solid foods before the age of four to six months. By then, your infant will have established the tongue and mouth movements necessary for swallowing solid foods and will be developmentally ready to try new tastes, textures and methods of feeding. A gradual weaning over weeks or months is the easiest way to introduce solid food. You can begin by replacing one breastfeeding a day with unsweetened fruit juice or formula, offering it in a cup or a bottle. By the time your baby is one year old, he or she should be eating a variety of different foods from the Food Guide Pyramid.
You should be aware that infants are quite susceptible to developing iron-deficiency anemia. For the first four to six months of life, your healthy baby will be protected against iron deficiency by elevated levels of hemoglobin in red blood cells, which will store up to 75 percent of his or her total iron requirements. As growth takes place, those resources will be depleted and you will need to add more iron to your baby’s diet.
As I mentioned earlier, an iron-fortified infant formula is recommended for bottle-fed babies because cow’s milk does not supply enough iron for your baby’s needs. Unfortunately, breast milk doesn’t supply enough iron either—it contains only between
0.3 and 0.5 milligrams of iron per liter. To prevent an iron deficiency, the American Academy of Pediatrics recommends a single grain, iron-fortified cereal, such as rice, as your baby’s first solid food. This should be introduced at four to six months of age.
When you decide to introduce solid food to your infant, you should offer only one new food at a time. That way, if your baby has an allergic reaction or digestive difficulties, you will know which food caused the problem. To prevent food sensitivities, you should avoid giving your baby cow’s milk, wheat, shellfish, egg whites and chocolate until he or she is at least one year old.
An infant’s calorie and nutrient requirements are higher than those for any other age group. If you restrict the fat in your infant’s diet, it may lead to an inadequate energy intake, a deficiency of essential fatty acids and failure to thrive. For this reason, dietary fat should not be restricted in children under the age of two years.
Do not feed your baby honey or foods that contain honey until he or she is one year of age. This sweetener may contain microbial spores that cause botulism. In infants, but not older children and adults, these spores can germinate in the intestine and produce a toxin which is then absorbed. Symptoms of infant botulism include poor feeding, constipation, loss of tension in the muscles, weakness and difficulty breath-
ing. Spores that cause botulism have also been found in corn syrup; however, no case of infant botulism has ever been linked to corn syrup.
Vitamin D Supplements
The only supplement a breastfed infant may require is vitamin D. This is the case only if your baby is restricted in his or her exposure to sunlight, since ultraviolet rays from the sun cause vitamin D to be produced in the skin. As this may well be the case from November through March in much of northern United States, your pediatrician may recommend a vitamin D supplement for infants from birth to 12 months old. After one year of age, your baby should be consuming food with vitamin D—egg yolks, cow’s milk, fish—and supplements may no longer be needed. Ask your pharmacist to recommend a vitamin D supplement for your infant.
Dental cavities are not a big issue in America, due mainly to the addition of fluoride to our drinking water. What seems to be becoming a problem instead is something called dental fluorosis, a cosmetic condition that shows up on the teeth as white specks, brown-gray stains or pitting. This is the result of increased availability of fluoride in drinking water, foods prepared with fluoridated water, toothpaste, mouthwashes, multivitamin and mineral supplements and so on.
For this reason fluoride supplements are not recommended from birth as they once were. If you live in an area that has little or no fluoride in the water, a supplemental dose of 250 micrograms is recommended from six months to three years of age.