by Jack Newman, MD, FRCPC
This is not an information sheet on all the ins and outs of working outside the home and breastfeeding. This sheet provides information on how your baby can be fed when you are not with him. It is addressed in particular to the mother who is returning to paid work when the baby is about 6 months of age or older. Mothers in Canada have the right to 52 weeks maternity leave. You should take full advantage of this time if it is at all possible.
Remember that there are costs to returning to outside work (transportation, clothes, daycare) that may cancel any benefit of increased income. If you cannot take a full year, take at least 6 months, better 7 months (from the point of view of ease of continuing breastfeeding while away from your baby). Your baby will never be this age again.
1. Babies must learn to take a bottle so that they can be fed when the mother is not there.
Why not an open cup? It is true that some exclusively breastfed babies will not take a bottle by 2 or 3 months of age. Most, who have not taken a bottle, and even some who once did accept a bottle will not take one by the time they are 4 or 5 months of age. This is no tragedy, and there is no reason to give a bottle early so that the baby knows how.
If your baby is refusing to take a bottle, do not try to force him; you and he may become very frustrated and there is just no need to go through all this. If the baby is at least 6 months of age when you start back at outside work, the baby quite simply does not need to take a bottle. If he is even 3 or 4 months, he does not need to take a bottle. He can be fed liquids or solids off a s
poon and by 6 months of age he can be taking enough so that he will not be hungry during the day. Furthermore, he can start learning to drink from a cup even by 1 day of age. The cup can be an open cup and is best not to have a spout (a "sippy" cup is, essentially, a bottle).
If, however, he has not got the hang of the cup by the time you must leave him, don't worry, he can take fluids off a spoon, or his solid foods can be mixed with more liquid (expressed milk, water). Obviously, if the baby is to be taking a fair amount of a variety of foods by 6 months of age, he may need to be started on solids by 5 months of age. However, some babies prefer to wait for their mother in order to drink something. This is fine; many babies sleep 12 hours at night without drinking or eating at all.
2. But getting the baby to take a bottle surely won't hurt.
Not necessarily true.
Some babies do fine with both. The occasional bottle, when breastfeeding is going well, may not hurt. But if the baby is getting several bottles a day on a regular basis, and, in addition, your milk supply decreases because the baby is breastfeeding less, it is quite possible that the baby will start refusing the breast, even if he is older than 6 months of age.
3. Babies need to drink milk when the mother is not at home.
Three or four good breastfeedings during a 24-hour period plus a variety of solid foods in goodly amounts gives the baby all he needs nutritionally, and thus he does not need any other type of milk when you are at your outside job. Of course, solid foods can be mixed with expressed milk or other milk, but this is not necessary.
4. If the baby is to get milk other than breastmilk, it needs to be artificial baby milk (infant formula) until the baby is at least 9 months of age.
If the baby is breastfeeding a few times a day and getting fair quantities of a variety of solid foods, infant formula is neither necessary nor desirable. Indeed, babies who have not had infant formula before 5 or 6 months of age often refuse to drink it because it tastes pretty bad. (If you want to convince yourself of how little we know about breastmilk, ask yourself why it is that, although breastmilk and infant formulas have the same amount of sugar, breastmilk is so much sweeter).
If you want to give the baby some other sort of milk, homogenized milk is acceptable at 6 months of age, as long as it is not the baby's only food. In fact, if the baby is taking good quantities of a wide variety of foods, breastfeeding 3 or 4 times a day, and growing well, homogenized milk or 2% milk is good enough, but also not necessary. The "need" for formula to 9 months to 12 months of age is basically formula company marketing and very successful at that. Statements by the Canadian Paediatric Society and the American Academy of Pediatrics urging formula to a year surely did not take into consideration the baby who is continuing to breastfeed after 6 months.
5. Babies need to drink milk to get calcium.
If you are worried about the baby's intake of calcium, he can eat cheese or yogurt. There is no need to drink the calcium. Besides, if the baby is also breastfeeding, breastmilk still contains calcium.
6. Follow-up formulas (artificial milk for infants over 6 months of age) are specially adapted to the needs of infants 6 to 12 months of age.
They are completely unnecessary and are specially adapted to the needs of the formula companies' profit margins. They also are part of a marketing strategy that tries to get around restrictions on the advertising of artificial baby milks directly to the public (widely disregarded in any case).
In Europe now, there are special formulas available for the toddler (1-3 years of age). In Singapore, they have formulas for children up to 7 years of age. Some people will buy anything, it seems. But these toddler formulas will soon be here in North America and soon nobody will consider it unusual to feed formula to a 3-year-old. In fact, just as some paediatricians in France now push formula to 3 years, some paediatricians in North America will too. You can bet on it. Bottom line über alles. We will all soon be on formula from birth to death.
7. The breastfed baby 4 months of age needs to be getting more iron than can be provided by breastmilk alone.
For the baby born at term who is breastfeeding exclusively, all the iron required is provided by breastmilk. However, by 6 months of age, more or less, it is prudent for the baby to begin getting more iron than that provided by breastmilk alone. The best way for your baby to get iron is through his food, and the best source of iron is meat, not formula, and not infant cereals.
8. The best way to assure the baby's getting enough iron is to give him infant cereals.
Infant cereals do contain a lot of iron, but most of it is not absorbed, and this amount of iron seems to cause constipation in some babies. Furthermore, some breastfed babies who have had only breastmilk to 5 or 6 months of age do not like cereal. There is nothing wrong with infant cereal, but pushing this food on reluctant babies may result in later feeding problems.
The best way to ensure the baby is getting enough iron is to continue breastfeeding, and introduce solid foods in a relaxed, enjoyable way at the appropriate time (See the information sheet Starting Solid Foods). The appropriate time is when the baby is showing interest in eating by reaching out for and trying to eat food the parents or other members of the family are eating. This occurs usually about 4½ to 5½ months of age. A baby this age can eat what the parents eat, with few exceptions. There is no need to be obsessive about the order in which foods are introduced, or trying to keep the baby eating only one food/week. The easiest way to give extra iron for the 6- to 12-month-old baby is meat, the iron of which is very well absorbed. Start feeding the baby solids in a way that makes eating enjoyable and the baby will eat iron-containing foods just fine.
Questions? Get Dr. Jack Newman's book The Ultimate Breastfeeding Book of Answers.
Jack Newman graduated from the University of Toronto medical school as a pediatrician in 1970. He started the first hospital-based breastfeeding clinic in Canada in 1984 at Toronto's Hospital for Sick Children. He has been a consultant with UNICEF for the Baby Friendly Hospital Initiative in Africa, and has published articles on the subject of breastfeeding in Scientific American and several medical journals. Dr. Newman has practiced as a physician in Canada, New Zealand, and South Africa.
What to Feed the Baby when the Mother is Working Outside the Home, February 2009©
Written & revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC & Edith Kernerman, IBCLC, 2008, 2009©