Expert: Sally Wendkos Olds - 6/17/2008

Question
Hello.  I have been exclusively breastfeeding my now 5 1/2 month old and wonder if I have a low supply.  He usually feeds every 2 to 2 1/2 hours during the day and every 3-4 hours at night.  He feeds off of both breasts and I can usually feel two let downs per side during his feedings which take about 20-25 minutes.  He always seems completely satisfied after eating but I'm wondering if it's not enough.  He does weigh 16 lbs and is in the 50th percentile for his height and weight.  I was told that maybe I should start introducing solid foods as he tries to grab food from plates and hands and that maybe that would lengthen out the feedings.  I'm just wondering what the average is for breastfed babies around 6 months as far as a feeding schedule goes and what the signs of malnutrition are.  Thanks


Answer
Dear Saboin,

First, congratulations for giving your son the best start in life by breastfeeding him!

It sounds as if your baby is doing just fine in terms of his weight and your milk supply. Feeling two letdowns per side during feedings is good -- you probably have more that you can't feel. He certainly does not sound as if he is suffering from malnutrition, which would include dehydration, listlessness, failure to gain, etc. Also, his development sounds good if he is grabbing food!

He is, though, nursing fairly frequently for a baby his age, and sounds as if he is ready to start solid foods. Ideally, the American Academy of Pediatrics advises waiting until six months before feeding solids, but many pediatricians (including Laura Marks, M.D. -- see below) favor the time between four and six months if a baby seems ready.

You might try giving him solids when he seems to want to nurse if he doesn't seem wildly hungry -- say, 2 to 2 1/2 hours after a feeding. This may hold him for another hour or so. At other times, instead of immediately picking him up to feed him you might do something else -- take him for a walk, play with him, give him a bath, and so forth. He may want your attention every 2 hours or so, but may not need to be nursed.

I'm attaching an excerpt from my book (see below) about starting solids. I hope some of these suggestions will help.

Regards, Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.

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Offering Solid Foods
• Nurse your baby first before you offer her food by spoon. She’ll be more open to trying a new experience if she isn’t wildly hungry.
• Pick a time when there are few distractions, and both you and your baby are relaxed.
• Sit her on your lap, where she will feel secure.
• Introduce a single-ingredient food first. If your baby develops a rash or any other symptom, you’ll be able to identify a possible cause.
• The first serving should be between one-half and one teaspoon of food.
• Use a spoon—the kind with a small bowl and a long handle works best. Do not feed solids from a bottle, since that can release too much food at once, causing a baby to choke.
• Start spoon-feeding by putting a little food into the bowl of the spoon, turning the spoon upside down, and scraping the food onto the top of the baby’s tongue. He will easily propel the food to the back of his mouth where he will swallow it. He’ll probably like it and will want more.
• Introduce new foods one at a time, over a fairly long period of time: There’s no need to rush in with a cornucopia of new foods.
• One good first food is iron-fortified rice cereal mixed with expressed breast milk, water, or formula; after your baby is a year old you can use homogenized milk. Rice is a good starter, since babies are least likely to be allergic to it.
• A good progression after iron-fortified rice cereal includes other cereals, fruits, vegetables, and meats. Among babies’ most enjoyed flavors are those of applesauce, bananas, pears, peas, carrots, and squash.
• Do not feed your baby directly from a jar of baby food. Take out the amount you plan to feed, and refrigerate the rest. If the baby doesn’t eat all of the food you removed, throw away whatever is left. The saliva that goes back into the food can foster the growth of bacteria.
• Do not heat food in a microwave; it may heat unevenly and make food too hot.
• Consider these first few feedings of solid foods “practice feeds,” just like those first few nursings so many months ago. Your baby now has to learn how to master a completely new set of muscle movements to take the food from a spoon and to swallow it. At first she’ll get more food on her face, her bib, and you than she will in her mouth. You’ll be surprised, though, at how quickly she’ll catch on, and how soon she’ll be ready to start eating foods she can pick up with her fingers.
• Ask your pediatrician which finger foods are safe for your baby. Some, like raw carrot or even zwieback, can cause choking if they’re given to a baby who cannot properly chew and swallow small enough amounts.
• Avoid, as much as possible, foods that contain added sugar, salt, and starch. You can make your own baby foods (which can be as easy as using a fork to mash a ripe banana or cooked peas). Or you can buy organic baby foods. Jarred foods may be more convenient when you are traveling, or when your table food is not appropriate for your baby.
• In any case, read the labels and graduate your child to table food as soon as she is ready. Commercial “stage 3,” “junior,” or “toddler” foods are unnecessary and costly.