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Breastfeeding Benefits: Breast Milk's Nutrients and How They Help Your Baby Grow

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Breastfeeding Benefits: Breast Milk's Nutrients and How They Help Your Baby GrowGrowth of Breastfed Infants
Human milk is nature's ideal diet for infants. When breastfeeding goes well, a baby will consume adequate quantities of human milk to meet all her nutrient requirements for about six months of life. Breastfed babies grow rapidly in the early weeks and months of life, putting on weight at least as fast as bottle-fed babies. Once a mother's milk comes in abundantly, her breastfed baby should start gaining about one ounce each day, or one and a half to two pounds each month, for approximately the first three months. Most babies double their birth weight at about four and a half months of age. Their early rapid weight gain pattern gradually tapers off (or else we'd all eventually be as big as elephants!). Babies don't triple their birth weight until about one year, and they quadruple it around age two. After the first three to four months, breastfed infants may gain weight less rapidly than bottle-fed babies during the remainder of the first year. The differences in growth patterns of breastfed and bottle-fed infants can give the false impression that an older breastfed baby's growth is faltering when it might actually be normal. I need to emphasize, however, that "faltering" growth in a breastfed infant during the first three to four months should not be considered normal. Early difficulties gaining weight probably reflect unresolved breastfeeding problems that should not be ignored.

Vitamin and Mineral Supplements
In the past, physicians routinely prescribed vitamin and mineral supplements for breastfed infants. Not only was this practice costly and usually unnecessary, but it also undermined women's confidence by implying that their milk was deficient. I recall being confused about why my first baby, Peter, required supplemental vitamins and iron if my milk was supposed to be "perfect nutrition." "How did babies in ancient times thrive without such supplements?" I wondered. Ironically, formula-fed babies don't require extra vitamins and minerals because formulas are fortified with them. Expectant and new parents can get the wrong message that breast milk is less nutritious than artificial baby milk if supplements are given to breastfed infants and not to formula-fed babies. Let me review the current recommendations for supplementation of healthy breastfed infants.

Multivitamins
The milk produced by a well-nourished woman has ample amounts of vitamins. However, poorly nourished women with vitamin deficiencies will produce milk that is deficient in vitamins. A few cases of vitamin-deficient milk and poor infant growth have been linked to a strict vegetarian diet in lactating mothers who weren't taking vitamin supplements.

Human milk is relatively low in vitamin D, but this vitamin is synthesized in the skin in ample amounts if a person is exposed to sunlight. Dark-skinned individuals require more sunlight exposure than light-skinned persons. Vitamin D deficiency can cause rickets (softening of the bones producing bowing of the legs and other bone deformities). A few cases of rickets have occurred in exclusively breastfed babies. The babies in whom rickets occurred were at particular risk because they were dark-skinned and received very little sun exposure. To prevent any chance of rickets, some physicians prescribe multivitamin drops for all breastfed infants instead of singling out those who get little sunshine exposure. Multivitamin preparations are used for this purpose because they actually are cheaper and more accessible than plain vitamin D.

Vitamin and/or mineral supplements may be required for premature infants and those with special health problems. Ordinarily, no vitamin or mineral supplements are necessary for healthy, breastfed infants of well-nourished mothers. Nevertheless, some doctors routinely prescribe liquid multivitamin preparations for breastfed infants "just in case." This practice probably does no harm beyond the added expense and hassle of trying to get your baby to take the vitamins. However, a few mothers report that their infants react adversely to vitamin preparations, either refusing them or acting fussy afterward. If that is the case with your baby, ask your doctor whether a valid indication exists for prescribing the supplements.

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Iron
Iron is an important mineral necessary for making red blood cells that carry oxygen to all parts of the body. When infants don't get enough iron in their diet, iron deficiency and anemia can occur and result in impaired development. Years ago, scientists noted that breast milk contained very little iron, compared to the amount present in iron-fortified formulas. The implication was that human milk was deficient in iron and that breastfed babies needed to be supplemented with this mineral. Yet, iron-deficiency anemia is seldom observed in breastfed infants. Several years elapsed before it was proved that the small amount of iron in human milk is exceptionally well absorbed by breastfed infants. Eventually, experts conceded that the relatively small amount of iron present in breast milk was sufficient for young infants. Mother Nature was vindicated again. After about six months of exclusive breastfeeding, infants deplete their iron stores and require additional sources of iron to prevent iron deficiency and anemia. Once semisolid foods are started, however, iron-fortified infant cereal is usually an adequate source of the extra iron needed by breastfed infants. No prescribed iron drops are ordinarily necessary for healthy, breastfed infants. Premature babies, infants born with low red blood cell counts, and babies with other special health needs might require supplemental iron on an individual basis. Whenever you have iron supplements in your home, keep them out of the reach of children! Many parents don't realize that an overdose of iron supplements can be deadly poisonous. Iron ingestion accounts for a number of childhood deaths each year. Infant drops, children's vitamin/iron tablets, and adult vitamin/iron preparations all are highly toxic when an overdose is taken.

Fluoride
One of the greatest public health discoveries of all time was the recognition that naturally occurring fluoride in drinking water supplies drastically reduces the incidence of dental caries, or cavities. Today, fluoride is added to many community water supplies. In low-fluoride areas, fluoride supplements are recommended for children, and until recently, some practitioners were starting supplements in the early months of life. Since human milk contains little fluoride, even where drinking water supplies are optimally fluoridated, supplements commonly were prescribed for exclusively breastfed infants under six months of age. In addition to the fluoride consumed from community water supplies or fluoride supplements, young children swallow fluoride-containing toothpaste during brushing.

Recently, increased numbers of American youngsters have been found to have dental fluorosis as a result of consuming excess fluoride. Fluorosis is a cosmetic problem in which the tooth enamel is discolored as a result of excess fluoride intake, especially in the preschool years. The appearance of fluorosis can range from barely perceptible chalky white specks to larger areas of pitting or brownish-gray staining. To prevent dental fluorosis, the Council on Dental Therapeutics and the American Academy of Pediatrics recently revised their recommendations for fluoride supplements for infants and children. Babies, even those exclusively breastfed, should NOT be given fluoride supplements in the first six months of life. Thereafter, infants whose families reside in nonfluoridated areas should receive fluoride supplements, although the recommended dosage has been reduced over the first six years of life. The drops can be prescribed by a physician or dentist.

If your community water supply is adequately fluoridated, your baby should NOT receive any supplemental fluoride, even after six months of age.

Water
I wish I knew the origin of the popular myth that breastfed babies require extra water. This widespread belief has no doubt done more harm than good. I suppose the practice originated decades ago when newborns were hospitalized for many days after birth. During this era, mothers and babies routinely were separated, feedings were rigidly scheduled and timed, and round-the-clock demand nursing almost never occurred. In this unsupportive environment, few babies obtained sufficient fluids from breastfeeding alone. Thus, it became common practice to offer newborns supplemental water after each nursing before the mother's milk came in abundantly.

The fact is that human milk is about 87 percent water. A baby who drinks enough milk to meet her other nutritional needs automatically will receive sufficient water. On the other hand, if a baby doesn't drink enough milk, giving extra water might prevent infant dehydration, but it won't make up for the shortfall in calories, fat, protein, vitamins, and minerals. Instead of water, what an underfed baby needs is more milk-human milk or infant formula if the breast milk supply is low. Ordinarily, healthy, thriving breastfed babies shouldn't need any extra water. When you find yourself thirsty on a hot day, be sure to nurse your baby more often to provide her extra fluids.