Tuesday, July 26, 2011

Breastfeeding Basics - Part V: Six Months to One Year

Thanks for sticking with me so far. I recommend you read the previous posts in this series before jumping in here, unless you have a baby in this age range and you just can't wait to find out what wisdom I have to impart.

Introduction, Parts I, II, III, IV

By now, you should be quite comfortable with nursing. You've gotten this far, which means you've met the first part of the recommendations from the AAP, the WHO, and many other health agencies in exclusively breastfeeding for the first six months. Breastfeeding should be feeling quite routine by now. You know your baby's cues. You've gotten through growth spurts. Your baby may even have a tooth or two, or will very soon. Your baby is growing and healthy and doing all kinds of "tricks," like rolling over, and probably sitting without support. Some babies even begin crawling around six or seven months of age. Your baby is interactive, loves to play, grabs and holds objects of interest and brings them to her mouth.

Introducing Solid Foods

So what's next? Well, at six months of age, if you feel you and your baby are ready, you can begin to introduce solid foods! "Solid" foods means any food that is not breastmilk.

A few things you should know before I start:
First of all, you don't have to give solids if you don't want to or if you feel like your baby isn't ready. Some babies of this age still don't quite know what to do with food when offered, while others have been trying to grab and eat your PB&J for a month already. Breastmilk still provides all of the nutrients, fats, and sugars your baby needs. Before the age of one or so, any solid foods are just for practice, for baby to get used to new textures and flavors and to learn to bring food to the mouth, "chew" it, and swallow it. You don't have to worry if it seems like your baby isn't getting a "full meal" of solids at first. Getting a hunk of banana from the plate to his mouth is an accomplishment all by itself, and getting that banana into his mouth and swallowing it is another. That's why he needs to practice!

Do not give whole (cow's) milk until your baby is over 12 months old.

There are two ways to introduce solid foods. One is to begin with baby cereals and/or vegetable and fruit purees and feed your baby with a spoon. The other is to give your baby safe finger foods and let him learn to pick them up and eat them at his own pace. My first son insisted on being fed purees for a long time before he started understanding how to feed himself, while my second son wanted nothing to do with spoons and purees and wanted finger foods almost from the start. That's not to say he ate much at first, but he learned. Like I said, it takes practice!

So where and how to start? Well, you want to start with a simple food. Rice cereal (found in the baby food aisle - we're not talking about Rice Chex, here!) is a popular first food, for two reasons: 1) It is vitamin-fortified, so your baby is getting necessary nutrients (especially iron); and 2) Rice is basically a hypoallergenic food, meaning your baby is very unlikely to have any kind of adverse reaction to it.

The best way to prepare rice cereal is to put a small amount in a bowl and add some expressed breast milk until it reaches the texture you want. Then you feed it to your baby using a small spoon. He may not quite get the idea at first, or he may just not like the taste. Offer a small amount and see how he does. Give him a few tries before you give up. Try it in the middle of the day, when he is alert and happy, and offer the food after breastfeeding, or in between usual feeding times. You don't want solids to replace breast milk meals just yet!

You can also start with pureed vegetables or fruits. Bananas, avocados, squash, peas, sweet potatoes/yams, and pears are all great first foods. Most breastfed babies will prefer sweeter foods first, as breast milk is very sweet. You can peruse the baby food aisle at your local supermarket for ideas on first foods - the jars labeled "Stage 1" are generally bananas, pears, squash, sweet potatoes, or applesauce, all of which are good to start with. I don't have anything against jarred baby foods, but if you prefer to prepare your own baby food, simply steam your fruits or veggies until they are very soft, then put them in the blender until you achieve the desired texture. You can freeze the purees in ice cube trays and thaw one per meal (each cube is one ounce of food), or keep them in empty baby food jars in the fridge, or whatever other solution you like. There are lots of ideas out there on the web! Bananas and avocados don't need to be cooked. You can just mash them with a fork!

If you want to try the finger-food method, you want chunks of food that are big enough for the baby to grasp in a fist or between thumb and forefinger. Banana is fantastic for this, or steamed baby carrots. As your baby gets better at grasping and mouthing the food, you can offer other simple, soft foods, including well cooked pasta, peas, potatoes, etc. Always supervise your baby's eating!

When you introduce new foods, start with simple, one-ingredient foods at first so you can observe for any kind of allergic reaction or intolerance. Introduce one new food at a time and wait a few days before introducing another new food, so that if the baby does have a reaction, you'll know what he reacted to. For example, if you give banana on Monday as his very first solid food, give only banana for a few days. Maybe Thursday you'll introduce pears. For the next few days, only give either bananas or pears. Then on Sunday, you could add carrots. Then you can give bananas, pears, or carrots at any given meal, until you introduce a fourth food a few days later. And so on. Once you've accumulated a "menu" of options, you can offer mixtures, like a banana-pear puree, since you know he can tolerate both bananas and pears. As the baby gets older, you'll introduce more interesting and complex foods, but it's good to start simple and small.

There are lots of good websites out there with ideas on what kinds of foods to offer at what ages. Yogurt is an excellent food to offer around nine months of age. Hold off on allergenic foods like peanuts until after a year. There are also other baby cereals, such as oatmeal and wheat, that are good to add to your baby's diet, if you're going the puree route. Oatmeal has a much higher nutritional value than rice and has a more interesting flavor, as well. You can also just give your baby real oatmeal!

Also, don't give a baby younger than one year honey. Honey can cause botulism, a potentially fatal form of food poisoning, in babies under a year old. Cooking the honey does not kill the spores that contain the toxin. After a year of age, the baby's immune system is mature enough to handle the spores.

Other Developments

During the second six months of life, your baby is learning all sorts of things. His brain is developing incredibly fast. He'll start to recognize his name and other important words. He'll start crawling and maybe walking. Along with mobility and increased understanding comes distractibility! Your busy baby may not want to stay at the breast for a long time anymore, which may be good news for you. He'll eat fast and then hop off to go explore again. Most babies nurse faster and less often after six months, which means you're no longer "tied" to your baby. Plus, once you've successfully introduced solid foods, you can get away for a couple of hours without having to worry about leaving a bottle. Whoever is caring for your baby can give him solid foods to keep him busy until you get back to nurse him! Remember that babies under a year old should still be getting the vast majority of their calories from breast milk, so don't let solids totally replace breastfeeding yet.

By the time your baby is approaching 12 months of age, if he is eating solids well, you may be able to start cutting back on nursing if you want. There is no need to cut back or stop if you don't want to! "Extended" breastfeeding past 12 months is still very beneficial for both you and your baby. In fact, the WHO recommends continuing to breastfeed until at least two years of age! We'll talk more about "extended" breastfeeding in the next section on toddler nursing.

But, if you're ready to stop at a year, I'll still say congratulations! You nursed your baby for a year! You made it! If you want to wean, you can start replacing breastfeedings with whole milk (at 12 months) in a cup or bottle and/or with meals of solid foods. Your baby needs the fats from some kind of milk (breast milk, cow's milk, goat's milk, soy milk, almond milk... something like that) for his brain development, so you'll want to make sure he's getting some kind of milk to drink. Weaning from the breast should be a slow process, for yours and baby's sake. If you wean abruptly, your baby will be very unhappy, and you may have to contend with engorgement and other discomfort. Instead, try cutting back by one feeding every few days, to give your breasts time to adjust milk production to the new, lower demand. If you want, you can continue to nurse once or twice a day, e.g. before bed and first thing in the morning. If you want to stop completely, those two are probably the last ones you'll be able to eliminate. Mid-day feedings are the easiest to replace with other foods.

The next and last post in this series will be about toddler nursing, which is a whole new source of enjoyment and frustration. You may have a taste of toddler nursing already, with nursing gymnastics, distractibility, and new habits that may not be totally desirable. But hopefully you're also finding new reasons to enjoy nursing.

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