Yes, you can breastfeed a baby to whom you did not give birth. In fact, breastfeeding an adopted baby is recommended by the American Academy of Pediatrics. It is even possible to breastfeed if you have never been pregnant or have reached menopause. Breastfeeding an adopted baby is different than breastfeeding a baby after being pregnant, but it can be achieved through the process of induced lactation.
There are several different methods used to induce lactation when you have not been pregnant. It may also be possible to breastfeed your adopted baby with no preparation at all. However, if you have advance notice that you will have a new baby joining your family, you may wish to explore methods that stimulate milk production before baby arrives. The same methods can be used by traditional adoptive mothers, mothers whose babies were born to surrogates, and even the female partners of birth mothers.
The physical connection of breastfeeding benefits both mother and child. ALL adoptions involve a loss for the child. Even a newborn infant who is placed right into the loving arms of his adoptive parents is being separated from the only mother he knows:
Adoption universally involves loss. Babies recognize their mothers at birth and at delivery healthy babies placed on the abdomen of their mother will crawl up onto her chest and, locating the nipple via its familiar smell, will attach to her breast and suckle. Newborn infants desire to remain with their mother and if removed from skin-to-skin contact with her will give a specific "separation distress cry/call" as an appeal for reunion. Maternal separation is stressful for infants, and all adopted children have experienced the loss of their birth mother (Gribble, 2006).
Inducing lactation before your baby arrives
When studying the various methods for inducing lactation, keep in mind that it is equally important to learn as much as you can about how the body is stimulated to make milk by the removal of milk from the breasts. Knowing the natural process of lactation can help you as you work to increase your milk production.
To prepare you can stimulate your breasts by hand or by pump for several weeks or months before your baby arrives. Hand expression requires no equipment and can be used to stimulate milk production.
If you use a breast pump it is recommended that you use the highest quality pump available to you when inducing lactation. The first choice would be a rental-grade pump, which you can find in your local area by contacting your birthing facility and asking what rental pumps are available near you and where. These pumps are often available for rent through hospitals, medical supply stores, WIC, private-practice lactation consultants, online vendors, and even some popular baby stores.
Whether you are using a pump, hand expression, or both, this method is most effective when done as many times a day as a baby would be breastfeeding, at least eight to ten times a day. Combining hand expression and breast massage with pumping has been shown to increase milk production more quickly (Morton, Hall & Wong, 2009). Many women begin to notice breast changes in the first 6 weeks of expression. Mothers may notice breasts that feel larger and firmer, breast tenderness, protruding nipples, and drops of milk.
Another strategy, which can be used in combination with others, requires you to take hormones and/or galactagogues daily to prepare your body for lactation (West, Marasco, 2009). A galactagogue is an herb or prescription medication that increases milk production, likely by increasing prolactin (the “milk making” hormone) levels in the blood. One method is called the Goldfarb-Newman Protocol. It involves first taking birth control pills to simulate pregnancy hormone changes and then both expressing and taking medication that increases hormonal levels. Herbal remedies such as fenugreek are available over the counter. You should discuss prescription medications and over the counter galactagogues with your health care provider. Variations in treatment may be appropriate according to the needs of an individual woman.
If you choose to use herbal or prescription galactagogues or hormones to facilitate lactation, it is important that you work with your health care provider. All of these substances have potential side effects and may be contraindicated for persons with certain medical conditions. Your health care provider can help you weigh any risks and benefits and decide what will work best in your situation. If you have questions about the safety of medications and herbs while breastfeeding or inducing lactation, contact the InfantRisk Center. The InfantRisk Center is dedicated to providing up-to-date, evidence-based information on the use of medications during pregnancy and breastfeeding.
Inducing lactation after your baby arrives
If you do not prepare before your baby arrives, you can still begin breastfeeding and expressing milk right away. You can also discuss the use of a galactagogue with your health care provider.
Some moms use an at-breast supplementer so that their babies can receive supplemental milk through a small tube at the breast. There are two main brands available: the Lact-Aid Nursing Trainer and the Medela Supplemental Nursing System (SNS). Both products work by allowing your baby to get supplemental milk while breastfeeding, but there are some differences in how they work. The SNS allows milk to flow by gravity, and comes with a variety of sizes of tubing for faster and slower flow. The Lact-Aid does not allow milk to flow unless baby is sucking. It is worthwhile to do some research on the pros and cons of these products before investing in one.
Bringing your baby to the breast
If your baby is being carried by a surrogate or in an open adoption where adoptive parents have been matched with the birth mother before birth, you may be able to be at the delivery of your baby and put your baby to the breast immediately. Babies are hardwired to breastfeed at birth. If you are able to put your baby to the breast right away then the procedures you will follow will be the same as if you had given birth to your baby, like those described in Baby-Led Latch: How to awaken your baby's breastfeeding instincts.
Even if baby has only had bottles, he may still instinctively root, search for, and take the breast when placed skin-to-skin on his mother’s bare chest. If your baby has a strong preference for bottles, it is still possible to teach him to breastfeed.
When you are working to teach your baby to take your breast, it is important to be patient and relax. The older your baby is, the more time it may take for him to be comfortable being skin-to-skin with you. A child who has experienced neglect or abuse will need time building trust and attachment before he will be ready to breastfeed (Gribble, 2006). There are many ways to get to know your baby and become comfortable being in the close physical contact required of breastfeeding:
- Spending lots of time lying down with your baby skin-to-skin
- Taking baths together
- Frequently carrying or wearing your baby during the day
- Sleeping near your baby
- Holding your baby while bottle feeding
- Sitting baby on your lap while giving solid foods
Maximizing milk production
Perhaps you have been preparing and inducing lactation for several months, or maybe you started when you met your baby. Either way, the key to establishing breastfeeding with your baby is time together. Research shows that adoptive mothers in developing countries are more successful at producing more milk than mothers in the West. These mothers in may have higher milk production due to cultural differences that are conducive to breastfeeding such as frequent breastfeeding and remaining in close physical contact with their babies. Their cultures may be more supportive of breastfeeding as well. Emulating the mothering styles of women in developing countries, and creating a support network for breastfeeding may help to maximize your milk production (Gribble, 2004).
The more your breasts are stimulated, and the more milk you remove, the more milk your body will produce. Be patient; the first milk you may notice will be a few drops, and the increase is very gradual. Nursing as much as possible is the best way to increase production and decrease the need for supplements.
- If at all possible, feed only at the breast using an at-breast supplementer.
- Offer both breasts twice at every feeding, and use breast compressions to maximize the amount of milk removed.
- Encourage comfort nursing between feedings. Offering the breast without supplemental milk flowing provides more stimulation to your breasts and keeps the baby interested and comfortable with nursing at a breast with less milk flow.
- If baby is unable or unwilling to nurse without the supplementer, consider expressing milk between feedings.
Finally, make sure you have built a support system. Consider contacting a Breastfeeding Counselor or International Board Certified Lactation Consultant to work with you. Read as much as you can about adoptive breastfeeding and induced lactation. The resources below will give you a place to start.
Adoptive Breastfeeding Stories
My Adoptive Breastfeeding Story
Breastfeeding My Adopted Child
We Are Breastfeeding
My Adoptive Breastfeeding Journey
Breastfeeding an Adopted Baby and Relactation, by Elizabeth Hormann.
The Breastfeeding Mother’s Guide to Making More Milk, by Diana West and Lisa Marasco.
Websites and online articles
Adoptive Breastfeeding Resource Website
Dr. Jack Newman: Breastfeeding your Adopted Baby or Baby Born by Surrogate
Buckley, K. & Charles, G. (2006) Benefits and challenges of transitioning preterm infants to at-breast feedings. International Breastfeeding Journal 1:13
Gribble, K. (2004) The influence of context on the success of adoptive breastfeeding: Developing countries and the west. Breastfeeding Review; 5-13.
Gribble, K. (2006) Mental health, attachment and breastfeeding: implications for adopted children and their mothers. International Breastfeeding Journal 1:5.
Horman, E. (2006) Breastfeeding an Adopted Baby and Relactation. Schaumburg, IL: La Leche League International.
Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational Carrier. (2009). Retrieved January 20, 2012, from http://www.nbci.ca/
Mezzacappa, E. S., and E. S. Katkin. (2002). Breastfeeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology 21:187-193.
Moore ER, Anderson GC, Bergman N. (2009) Early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Summaries
Morton J, Hall, J and Wong, R et. al. (2009, July, 2) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology advance online publication; doi: 10.1038/jp.2009.87
West, D. and Marasco, L. (2009) The Breastfeeding Mother’s Guide to Making More Milk. McGraw-Hill.
© Teglene Ryan
Satiety cues are your baby’s way of showing he is satisfied and no longer hungry. Here are a few cues you might recognize at the end of breastfeeding:
- Baby’s hands are open and relaxed
- Baby’s body feels relaxed, “loose”
- Baby may have hiccups but is calm and relaxed
- Baby may fall asleep
- Baby may have a “wet burp” (milk can be seen dribbling out mouth)
- Baby seems peaceful
Note the newborn's open hand, a signal that he is relaxed and getting full!
More info: Breastfeeding on cue or baby led feedings
References: Wilson-Clay, B., Hoover. K (2005) The Breastfeeding Atlas Manchaca, Texas. LactNews Press
Part of the mission of Breastfeeding USA is to provide evidence-based information. What does that statement mean? What is evidence? In the strictest sense, it is information that is backed by solid, peer-reviewed research based on established scientific principles. For a very long time, there was little strong empirical evidence related to breastfeeding, and most of the existing research was concerned with the components of breastmilk. Thankfully, there is now a growing body of research on many aspects of breastfeeding. Sometimes, the results affirm what we already suspected to be true, and sometimes they are surprising. The strongest information is provided by systematic review of randomized, blinded, controlled trials. The problem with waiting for this type of affirmation is that these types of trials are either very involved and expensive or impossible to conduct. Who will pay for this kind of investigation into best breastfeeding practices? And even with the best research, there can be questions about whether the results can be generalized to a large population.
So, what if there is no research on a particular topic? There are many common breastfeeding (and medical) practices that have no formal research to support them. From an editorial in the British Medical Journal in 1996, "The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." This article stresses the need to customize the application of new information based on the client's circumstances and preferences. What are the implications for Breastfeeding Counselors? We should use the results of the latest and best research, our own observations, and the experiences of others working with breastfeeding dyads to make decisions when working with mothers and babies.
We have seen the problems inherent in using anecdotal information and poorly-designed research. For example, we no longer advise mothers to toughen up their nipples or to nurse their babies in only a few, very specific positions. Indeed, recent ultrasound studies seem to negate the very existence of the long-recognized milk sinuses that (we thought and taught) babies needed to compress in order to receive milk. Those individuals working with breastfeeding dyads need to more systematically document and share what they are seeing and how mothers and babies respond to various interventions so that we can advance our knowledge of what truly works and what doesn't. Counselors and health professionals should not routinely offer suggestions that many others have found are rarely successful. If we have access to the combined observations of many skilled counselors and health professionals, we can feel more confident in using information that is not backed by formal research. Also, we must be careful to differentiate between observation and interpretation. It is not unusual for two people to witness the same event and have different ideas about what they have seen: does a swaddled baby stop crying because he is calmed and happy or because he is overwhelmed and has shut down?
An evidence-based practice is balanced. We must consider the circumstances, values, and preferences of the mothers we serve as we share our evidence-based information. Without the best current and classic external research, practice and information become outdated and may be ineffective or even harmful. Without clinical and/or personal experience, practice and information risk becoming solely research-dominated and may not take an individual mother's needs into account. Without taking into consideration the mother's values, preferences, and realities of life, practice and information become irrelevant and may become unethical.
Maintaining current knowledge of the latest, peer-reviewed research is very important for anyone who is helping mothers and babies succeed with breastfeeding. In the absence of such research, we can include, thoughtfully, the body of experience that many counselors and professionals have developed in breastfeeding their own children and through helping other dyads. An evidence-based practice not only presents the best information available but also respects the mother's right to evaluate that information and use it to make informed decisions for her family. We must not forget that much of our role as counselors has nothing to do with facts and figures but is instead focused on making a connection with another mother and empowering her to make the best decisions for herself and her baby.
The Cochrane Collaboration is a great resource for finding out more about evidence-based research and practice.
Sackett, D., Rosenberg, W., Muir Gray, J.A., Haynes, R.B., & Richardson, S. (1996). Editorial Evidence Based Medicine: What it is and What it isn't. British Medical Journal 312:71.
NOTE: This is the third and final article in a series about weaning.
Depending on where you live, “weaning” may mean either introducing other foods or stopping breastfeeding. In this article, we are talking about weaning from the breast.
You may want to read the previous articles first:
When is the Best Time to Start My Baby on Foods Other Than Breastmilk?
Good Foods for Babies
Kendra was confused. “Before I had Jason, everyone was after me to breastfeed. They said it would be good for the baby. So why do they now keep asking me when I am going to wean him? Even some of the articles I read say that there is no reason to keep nursing after the first few weeks. Is this true?”
Tanya had a similar question. ”When I was still pregnant with Davy,” said Tanya, “I thought I would only nurse him for a few weeks before switching to formula. But now I have come to realize how much we both love breastfeeding, and I feel sad when I think about stopping. Davy is 9 months old and eating all kinds of other foods as well as nursing. When am I supposed to wean him?”
There is good news for both of these mothers: human milk does not suddenly turn to water after a certain length of time! Mothers can nurse their babies for as long as both they and their children wish to continue. Children will wean all by themselves when they are developmentally ready to do so.
Your milk continues to provide both food and health benefits even after your baby has begun to eat other foods. In fact, it continues to be the most important part of your baby's diet until he is about a year old. Did you know that the American Academy of Pediatrics (AAP) recommends that babies continue to nurse until they are at least a year old and that the World Health Organization (WHO) recommends continuing to nurse for at least two years?1,2
Many mothers are surprised to learn that during their baby’s second year (12-23 months), 15 ounces of their milk provides:
- 29% of energy requirements
- 43% of protein requirements
- 36% of calcium requirements
- 75% of vitamin A requirements
- 76% of folate requirements
- 94% of vitamin B12 requirements
- 60% of vitamin C requirements 3,4
Why do so many mothers worry about weaning?
I'll bet you have never heard a mother say, “I will make him walk by the time he is xxx,” or “I will make him talk by the time he is xxx.” We KNOW that you cannot make a baby walk or talk before they are ready to do so! All babies are different, and there is no reason to set an exact date. The same goes for weaning; children wean when they are ready.
What can I say to people who ask when I am going to wean?
It depends who is asking. For example, you could:
- Explain that breastfeeding is the healthy option.
- Make a joke like, “Until she goes to an out-of-state college!”
- Tell them that your doctor recommends natural weaning.
- Share that natural weaning is a family tradition.
And if all else fails, ask why they need to know!
Weaning is a process, not an event!
As he gets older, your baby will gradually eat more table foods. You will notice that he needs to nurse less frequently or for shorter periods of time. However, babies nurse for many reasons besides the need for food. Even when he becomes a toddler, your baby may still need to nurse when it's time to go to sleep, when he wakes up, or when he has a boo-boo.
There will also be days when he needs to nurse more than usual: perhaps when he is teething or coming down with a cold. Nursing can help him cope with these upsets. In fact, many mothers say they could not imagine getting through the toddler stage without nursing to smooth the way. All too soon, as he progresses in natural weaning, your little one will be too busy exploring the world to nurse as often.
But what if I want a night out with my partner or friends or to go to the gym?
- You can pump or hand express some milk to leave for your baby while you are away.
- Be sure to nurse immediately before leaving, so that you both will feel comfortable.
For more information on leaving breastmilk for your baby while you are apart, see our article: Breast vs. Bottle: How much should baby take?
What if I have to go back to school or work?
- You do not have to wean completely from the breast!
- You can nurse when you are home and pump when you are away, and your sitter can give your baby your pumped milk.
- Even if you decide to use formula while you are away, you can still nurse when you are home. Even a little milk is important to your baby's health!
What if I get sick and need to take medicine?
Most medications are safe to use when breastfeeding. For those medicines that are not safe, there is almost always another, safer drug available. Your healthcare provider can look them up online at Lactmed, a free government service, before writing a prescription.
The InfantRisk Center www.infantrisk.com provides answers to questions about the use of drugs during pregnancy and breastfeeding. Call (806)-352-2519 for information about the safety of using drugs, over-the-counter drugs, herbal products, chemicals, vaccines, and other substances.
Remember, you can always get a second opinion!
What if I want to have an alcoholic drink?
Here are some things you will want to know:
- Only a very small proportion of the alcohol will go into your milk.
- Nurse the baby before having your drink.
- There is no need to pump and dump, because the alcohol will pass out of your milk in the same way it passes out of your blood.
- It takes about two hours for complete metabolism of one standard drink (12 oz of 5% beer, or 5 oz of 11% wine, or 1.5 oz of 40% liquor (80 proof) 5
- If you are fit to drive, then you are fit to nurse.
- If you are planning on drinking a lot, express your breastmilk ahead of time so that your baby will have milk to drink until you are sober.
- Be sure to have somebody else care for your baby until you are able to do so safely.
- Do not sleep in the same bed as your baby if you have been drinking.
What if I get pregnant?
- It is usually safe to nurse through a pregnancy.
- According to Lesley Regan, PhD, MD, head of the Miscarriage Clinic at St. Mary’s Hospital in London, the largest referral unit in Europe, and the author of Miscarriage: What every woman should know:
"Once a pregnancy is clinically detectable, breastfeeding should pose no added risk of pregnancy loss. There isn’t any data suggesting a link between breastfeeding and miscarriage, and I see no plausible reason for there to be a link." 6
- Many women continue to nurse while pregnant. During early pregnancy, your milk production may go down as the milk changes back to colostrum. Your baby may not like the taste and wean on his own, but many babies continue to breastfeed throughout pregnancy. Some mothers develop sore nipples when they become pregnant. If you have this kind of soreness, you can think about offering shorter nursing sessions rather than weaning completely.
- It will not hurt the new baby if the older child also nurses. A mother who is “tandem nursing” makes enough milk for both children, just as if they were twins.
But people tell me that weaning will make life easier!
- As a general rule, babies who are weaning need MORE attention, holding, and comforting!
- Breastfeeding is much more than food: it is comfort and medicine, too. Your baby will still need to be held and cuddled when feeding. A propped bottle is a choking hazard, and there is a serious risk of aspiration pneumonia.
- Although some partners start off by doing the night feeds, most don't continue for long, and then it will be you getting out of bed every night to heat a bottle when your baby cries.
- Your baby is more likely to get sick if he is not getting antibodies from your milk, so you may be spending more time at the doctor's office and need more time off work.
If you need to wean before your baby is ready...
Do what feels right for you and your family. Each mother's circumstances are different!
- If your baby is under a year old, talk to your doctor about which formula to use and mention any allergies that run in the family.
- If your baby is over a year old, ask your doctor about using other milks instead of formula. You may be able to go straight to a cup.
- Each time you are ready to drop another nursing, let your baby nurse briefly at that feeding before offering the bottle during the first couple of days. This process will help him get used to the bottle more gradually. It will also help to prevent you from becoming over-full and maybe developing mastitis. If you still feel uncomfortable, pump or hand-express JUST ENOUGH to relieve pressure.
- Let another person be the one to feed him the bottle if you will be only partially weaning. You will want your baby to associate you with breastfeeding only. Be prepared to backtrack. There will be days when your baby is not feeling well and needs to nurse. It is NEVER wrong to listen to your baby! Two steps forward and one step backwards is quite normal.
Bottle feed as much like breastfeeding as possible.
- Use a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind.)
- Start by resting the tip of the nipple on your baby's upper lip, and allow him to take it into his mouth himself, just as if he was nursing.
- Keep the bottle only slightly tilted, with baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel as if he is drowning.
Start by substituting a bottle for one nursing a day for about a week. Keep your baby's favorite nursing sessions for the last. Follow your baby's lead as much as possible. For example, if he is sick, you may want to nurse a little more often until he is feeling better again. Unless there is an urgent reason for immediate weaning, it is easier on both of you to go slowly.
Remember, you know your baby best, and you know what is best for your family. Trust your instincts, and you won't go far wrong.
Want to know more about weaning?
Here is a great book:
How Weaning Happens by Diane Bengson
Here are some articles you may find helpful:
“A Natural Age of Weaning” by Katherine Dettwyler, PhD
Breastfeeding Past Infancy: Fact Sheet
Comfort measures for mom during weaning
1. The American Academy of Pediatrics (AAP)
2. The World Health Organization (WHO)
3. Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 2005 Sept; 116(3):e432-e435.
4. Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).
5. Texas Tech University Health Services Center (InfantRisk Center) http://www.infantrisk.com/content/alcohol-and-breastfeeding
6. Flower, H., Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond, 2003.
NOTE: This article is the second of a series about introducing solids and weaning. You may want to read the previous article first: When is the Best Time to Start My Baby on Foods Other Than Breastmilk? The final article in this series is: Thinking About Weaning?
As her baby approached his six month birthday, Joanna had lots of questions about starting her breastfed baby on other foods.
“Those jars of baby food are cute but so expensive. Besides, I would really prefer to feed my baby fresh food. Is it difficult to make your own baby food?"
It is very easy to make your own baby food and much cheaper, too. You do not even need special equipment, just a knife, fork and spoon.
“What are some good “starter” foods?”
Most babies like soft fruits and veggies. You can put tiny pieces of ripe banana on his tray, so he can pick them up and feed himself while you eat your dinner. Sweet potatoes are great for babies. Just scrub and prick the skin of the potato and bake it in the microwave until it is soft. After it has cooled down, you can throw away the skin and cut up the soft potato into little chunks.
“I have never heard of babies feeding themselves! I thought you had to feed them with little spoons!”
We used to think it was a good idea to start babies on solid foods when they were very young, maybe even just a few weeks old. Of course, babies that age could only eat pureed foods, which their mothers fed them with spoons. Now we know that babies are not ready for solid foods until they can sit up by themselves and use a pincer grasp with their fingers and thumbs. By that time, they can eat all kinds of things with only a little help from you. Your baby may like sitting in a high chair to eat, or he may prefer to sit on your lap or on the floor.
“Why do so many babies start with cereal?”
Cereal may be traditional, but it is not necessarily one of the best first foods. Iron-fortified rice cereal has been suggested as a first food in the past because of the belief that it was “hypoallergenic” and was a good source of iron. A review of research by the American Academy of Pediatrics (AAP) finds those reasons to be invalid. 1 Newer thinking suggests beginning with foods that are naturally nutrient-rich. For example, meat is naturally rich in iron and zinc. In any case, breastfed babies usually get all the iron they need from their mother's milk up until at least six months of age. 2 If your doctor is concerned about iron levels, a simple blood test can be done right in the office.
“So what else could I feed my baby?”
Lots of things! Just make sure the food is soft enough not to catch in his throat and that it is cut into little pieces. So, for example, you will want to offer cooked, not raw, carrots, green beans, and peas.
- Try ripe avocados, pears, peaches or apples – whatever is in season.
- Beans can be mashed after the skins have been removed.
- If you eat meat, you can offer little pieces of chicken or maybe a meaty leg bone (with that thin sliver of attached bone removed).
- Tofu is an easy, soft food for a meat-free family with no soy allergies.
- As he gets closer to a year, your baby may also like to gnaw on a heel of whole wheat bread or a piece of bagel.
“Are there foods I should avoid feeding to my baby?”
- Don't give her anything that could get stuck in her throat, so avoid hard foods like popcorn and nuts and sticky foods like peanut butter.
- Any “round” foods, like carrots slices or grapes, should be cut into quarters.
- You may have heard that you should delay potentially allergenic foods, and you may have seen lists of such foods. Current research suggests that there is no benefit or reduction in the development of allergies due to delaying certain foods. 1
- Never give honey to a baby until he is over a year old because of the risk of botulism (food poisoning).
- If there are any foods or drinks to which members of your family are allergic or sensitive, talk with your health care provider before offering them to your baby.
“How much food does he need? How many times a day should I feed him?”
Start slowly, just once a day. If you miss a day, don't worry. Table foods may be offered whenever it is most convenient. It is not necessary to stick to a strict daily schedule. At first he will mostly play with his food. If any of it gets in his mouth, consider it a bonus! Start with about a teaspoon of food and add more when he asks for it. You might want to put an old shower curtain under his chair to catch the crumbs. Wait about a week before introducing each new food. That way it will be easy to see if anything upsets his stomach or gives him a rash.
“What about juices? Won't he need extra water too?”
Whole fruits contain fiber and are much more nutritious than juices. It makes sense to either limit juices or even avoid them completely. Some mothers like to offer a little water in a sippy cup with meals.
“Wow, I am excited to start! But I was wondering, if I start on other foods, won't he nurse less often? I don't want to lose my milk, and I am not ready to stop nursing.”
Your milk remains the most important part of your baby's diet until he is about a year old. Always nurse him before offering other foods and afterwards as well if he is interested. Nursing before offering solids will both ensure that baby gets enough breastmilk and maintain your milk production.
Babies need only their mother’s milk for about the first six months. Your baby will continue to receive the same nutrition and protection from your milk as long as you continue to nurse.
The continuing protection from illness is important for your baby, because when babies become more mobile, they are toddling around and picking up all kinds of germs, some of which go straight into their mouths.
It is fun to see your baby begin to explore the different tastes and textures of various foods.
You may also like to read:
Baby Led Weaning and More on Baby Led Weaning http://www.babyledweaning.com/
Whole Foods for Babies and Toddlers by Margaret Kenda
Mash and Smash Cookbook by Marian Buck-Murray
Sugar-Free Toddlers by Susan Watson
My Child Won't Eat! by Carlos González, MD
1. American Academy of Pediatrics Committee on Nutrition. Pediatric News, November 2009: “Rice Cereal Can Wait, Let Then Eat Meat First: AAP committee has changes in mind”
2. Raj, S et al. “A prospective study of iron status in exclusively breastfed term infants up to 6 months of age”, International Breastfeeding Journal, 2007.
The World Health Organization and the American Academy of Pediatrics (AAP) recommend that babies be exclusively breastfed for six months before other foods are introduced. Some babies are ready to start new foods around this time, while others show no interest until they are a bit older. The Recommendations on Breastfeeding by the AAP also state:
“Unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as four months of age, whereas other infants may not be ready to accept other foods until approximately eight months of age.
Introduction of complementary feedings before six months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.”1
As you can see, there is no clear cut age when it is best to start solids. The best time to start offering your baby other foods is when he shows signs of being ready.
Of course this time will be different for each baby. We do not expect all babies to crawl or walk or potty train on a certain day of their lives, and we should not expect them all to need solid foods at the same time either. You are the expert on your baby!
Here are some of the signs that your baby may be ready for solids.
He will be able to:
- sit up on the floor for about ten minutes without support 2
- use his finger and thumb to pick up toys and put them in his mouth
- swallow a tiny bit of soft food, like ripe banana, without pushing it out of his mouth with his tongue
At this stage, he will probably also seem to be more hungry than usual. If you have already tried nursing him more frequently, and he still does not seem to be satisfied, he may be ready to start adding other foods to his diet. Babies sometimes also want to nurse more because they are teething or not feeling well or going through a growth spurt, so be sure to rule those things out first.
Mothers sometimes wonder if their babies are ready for solids at about four months because of the way their babies are behaving.
Four months is about the time that many babies start to become more interested in the world around them. They are taking everything in. For example, they may pull away from the breast in response to a sudden noise. They may even try to take the breast with them! They may not seem to be as interested in nursing so often or may learn to gulp down their milk quickly to get back to more fun activities.
These are all normal and common ways for four-month-olds to behave. You may find it helpful to nurse your baby in a quiet, dark room a couple of times during the day in order to avoid distractions. Some mothers like wearing a nursing necklace (beads strung and knotted on extra-strong cord that the baby can hold while nursing) because it can help him stay focused on breastfeeding.
Have you noticed your baby watching you very carefully while YOU eat? Does he pretend to chew? This behavior shows how babies learn and practice, and it is one of the signs that they will soon be ready to start eating table foods.
Just follow your baby's cues and your own instincts.
There is no rush. Nothing magical happens on the very minute/hour/day of the sixth month birthday. A switch does not suddenly turn off and make mother's milk suddenly inadequate! In fact, some babies have no interest in other foods until much later, sometimes not until they are about a year old.
As long as your baby is happy and healthy, gaining weight, and meeting all his milestones, he is doing fine!
Some parents are told that they must introduce solids by a certain age to provide extra iron and prevent anemia. If there is a concern about your baby's being anemic, your doctor can do a simple blood test. It only takes a few minutes to see if your baby has enough iron. It is almost unheard of for a completely breastfed baby to have low iron stores or low hemoglobin values before six to nine months. One study, by Piscane, 1995 3, found infants who were exclusively breastfed for seven months (not given iron fortified cereals or iron supplements) had significantly higher hemoglobin values at one year old than breastfed babies who had received solid foods before seven months. None of the babies who were breastfed exclusively for 7 months were anemic at one year, while some of the babies who did receive solids before seven months were found to be anemic. Research like this suggests that delaying solids can reduce the risks of anemia.
Enjoy this special time with your completely breastfed baby. You may be interested in reading the next article in this series, Good Foods for Babies, where I share some suggested first foods and ways to introduce your baby to the delights of a wide variety of healthy foods.
You may also like to read:
Starting Solids-The Facts Behind Today's Media Hype
1. American Academy of Pediatrics. Policy Statement on Breastfeeding and the Use of Human Milk, PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491)
2. Hassink, Sandra G. MD, FAAPA Parent's Guide to Childhood Obesity: A Road Map to Health, American Academy of Pediatrics, 2006 http://www.healthychildren.org/English/ages-stages/baby/feeding-nutritio...
3. Pisacane A, et al. Iron status in breast-fed infants. J Pediatrics 1995 Sep;127(3):429-31
One of the things that we can depend on, unfortunately, is that disasters and emergencies will continue to happen around the world. From tornadoes and hurricanes to earthquakes and floods to the effects of war, few people are immune to the possibility of dealing with at least one or more of these situations sometime in their lifetime. During a disaster or emergency, breastfeeding becomes even more important and has been proven to save lives.
The American Academy of Pediatrics states:
In an emergency
• There may be no clean drinking water.
• There may be no sterile environment.
• It may be impossible to ensure cleaning and sterilization of feeding utensils.
The cleanest, safest food for an infant is human milk.
Below is a list of resources for those looking for detailed information about breastfeeding during emergencies:
Emergency Nutrition Network: http://www.ennonline.net/resources/6
IBFAN (International Baby Food Action Network): http://www.ibfan.org/fact-feeding_emergency.html
American Academy of Pediatrics: http://www.aap.org/breastfeeding/files/pdf/InfantNutritionDisaster.pdf
Transcript from WHO podcast from 2009: The importance of breastfeeding during emergencies
Australian Breastfeeding Association: https://www.breastfeeding.asn.au/bfinfo/infant-feeding-emergencies
Power Outage: Handling milk safely
Emergency Baby carriers (broken glass is a real concern!)
Breastfeeding USA. All Rights Reserved.
Accredited Breastfeeding Counselors are listed by location. They are volunteers working from their homes, so please be considerate of the time of day when calling. Please note the type of service offered in italics. These services may include telephone helping (phone), support gatherings (meeting), and electronic consultation (email).
Metro Phoenix Chapter
meeting, phone, email
Charlene (480) 543-9162 email@example.com
Mother-to-mother support meeting information: First Thursday of the month, 10:15 AM at Kids Rising, 2701 E Thomas Road, Suite H, Phoenix, Arizona, 85016
Connect with other mothers in the Metro Phoenix area on Facebook.
Amador, Calaveras, Tuolumne Counties Chapter
meeting, phone, email
Teglene (209) 795-4393 firstname.lastname@example.org
Jen (209) 985-9284 email@example.com
Facebook: Motherlode Moms
Breastfeeding USA/Antelope Valley
phone, email, meetings, in-person, text
Angela Hayes (323) 450-7969 firstname.lastname@example.org
Meeting info coming soon.
phone, email, in-person
Cristy (951) 532-7258 email@example.com
Meetings held 2nd Thursday of every month.
San Francisco Bay Area Chapter
Patty (510) 522-0979 Patty.J@BreastfeedingUSA.org
Castle Rock Chapter
phone, email, meetings
Kari Wheeler (303) 880-4534 firstname.lastname@example.org
Meetings: First Friday of every month, from 11am to 12pm, at the Family Enrichment Center, 107 5th Street, Castle Rock
Front Range Chapter
Sharon (315) 331-2140
Grand County Breastfeeding Network
phone, email, in-person visits, monthly meetings
Rosalie (303) 478-2054 Rosalie.rust@breastfeedingUSA.org
Meeting information: 4th Thursday of the month, from 2-3 pm, at the Pregnancy Resource Connections building in Granby Colorado.
Morgan County Nurslings
phone, email, home visits
Cassie Potts (970) 370-4948 email@example.com
meeting, phone, email
Nicky Prince (860) 729-2970 firstname.lastname@example.org
Becca Dean (860) 916-5543 email@example.com
Jennie Bernstein (860) 372-5276 firstname.lastname@example.org
Shiyrah S (860) 880-0817 email@example.com
Jaime Lyn Procaccini Savino (860) 644-2117 firstname.lastname@example.org
Joy Delaney (860) 375-0569 email@example.com
Alexis Hennessey (860) 281-1121 firstname.lastname@example.org
Carol Delaney (860) 644-4109 email@example.com
Erica Grossman (860) 404-2655 firstname.lastname@example.org
Mia Gonzalez (860) 967-4693 email@example.com
Spencer Joslin-Montlick (860) 285-7448 firstname.lastname@example.org
Jennifer Olynyk (860) 870-4122 email@example.com
Facebook: Connecticut Chapter of Breastfeeding USA
- 2nd Monday of each month, 6pm: Goodwin College, 211 Riverside Drive, FIP Room 311, East Hartford, CT
- 3rd Monday of each month at 7:30pm: Indian Valley YMCA (childcare room), 11 Pinney Street, Ellington
- 2nd Tuesday of each month, 6:30pm: East Hampton Public Library 105 Main st. East Hampton CT
- 1st Wednesday of each month at 7pm: Outer Peace Wellness, 12 North Main Street, West Hartford
- 2nd Saturday of each month, 10:15am: 7 Elm Street (St. Francis Access Center), Enfield, CT room 301
- Last Thursday of the month, 6:00pm: YWCA New Britain, 19 Franklin Square, New Britain, CT
Middle Georgia Chapter
phone, email, in-person
Evelina (919) 619-0965 firstname.lastname@example.org
phone, email, text, in-person
Denise (478) 952-9151 email@example.com
Monthly breastfeeding support meetings hosted in collaboration with the Middle Georgia Breastfeeding Alliance.
Southeast Georgia Chapter
phone, email, in-person
Megan (337) 277-1885 firstname.lastname@example.org
Group support meetings are expected to start in March of 2014.
West Oahu Chapter
Naomi S. (808) 221-3179 email@example.com
BFUSA West Dundee
phone, email, meetings
Beth & Aimee (630) 220-0765 firstname.lastname@example.org
Babies and children always welcome. Meetings always free of charge.
Weekday Chapter meetings: Second Tuesday of each month from 10 AM- 12 noon at Radiant Heart Yoga, 647 S 8th St, West Dundee, IL 60118.
Nursing Beyond Infancy meetings (for those seeking support for nursing older babies (over 5 months) and toddlers, 2014: January 21, March 4, April 15, May 27, July 15, August 26, October 7, November 18, December 16 at Radiant Heart Yoga, 647 S 8th St, West Dundee, IL 60118.
phone, email, meeting
Ashley (217) 391-3946 email@example.com
Meeting: 3rd Monday of every month, 7-8:30pm at the Urbana Free Library.
Find us on Facebook!
Chicago - Northside Chicago Chapter
phone, email, meetings, text, in-person
Aimee Barker firstname.lastname@example.org
Meeting Info: Every second Saturday of the month, 10 am-11am, Epiphany United Church of Christ, 2008 West Bradley Pl, Chicago, IL 60618. No parking lot, but there is ample free street parking. Enter at side door, near garden area, meeting is in the basement. Unfortunately the basement is not handicap accessible. There is a small area inside where a few folded strollers could fit. Meetings are always free. Babies and children welcome.
Chicago - West
(Serving the areas near Chicago's western suburbs)
phone, email, meetings, in person, text
Maura Frauenhofer (716) 799-3290 email@example.com
First Saturday of the month, 9am-11am
Third Monday of the month, 10am-noon.
Both take place at Mission House Cafe located at 6818 W 34th St, Berwyn IL 60402
Facebook Page: Please check our page the day of meetings in case of changes or cancellations.
Danika Amusin (773) 510-3416 firstname.lastname@example.org
Shevy Lowinger (773) 733-3245 email@example.com
meeting, email, phone
Colleen and Karyn
(815) 317-6065 firstname.lastname@example.org
Facebook: Breastfeeding USA- Joliet Chapter
Meetings are held the 4th Monday of the month, 7:00 PM. No RSVP required. Meetings held at ANEW Medical and Rehabilitation 115 Republic Ave. Joliet, IL 60435
Lake County Chapter, Mundelein, Baby and Me
meeting, phone, email
Nancy (847) 404-0219 email@example.com
Meeting time and location: 2nd Friday evening of each month 6:30 PM - 8:00 PM
Hosted at: Cygnus Lactation, 404 N. Seymour, Mundelein, IL 60060
One block east of Rt. 45 on the NW corner of Hawley and Seymour
McHenry County Chapter
Erika (847) 483-8968 firstname.lastname@example.org
Come Join us on Facebook!
Mt. Vernon Chapter
meeting, phone, email
Rose (618) 204-9081 email@example.com
Meeting time and location: 2nd Tuesday evening of each month 6:30 pm
Hosted at: First United Methodist Church 1133 Main St. Mt. Vernon, IL (enter through back door)
Schaumburg Area Chapter
phone, email, meetings
Tracy Torgerson (224) 200-7031 Tracy.firstname.lastname@example.org
Chapter meetings are held the 3rd Wednesday of the month @ 7:00 PM to 9:00 PM
Schaumburg Covenant Church, 301 N. Meacham Rd., Schaumburg, IL
Spring Grove, IL Chapter
Paula Welter (815) 403-1572 email@example.com
Meetings Coming Soon!
Facebook: Spring Grove, IL Chapter
Hamilton County Moms Breastfeed
meeting, email, phone
Amie (317) 674-3237 Amie.Hood@breastfeedingusa.org
Elissa (317) 674-3237 firstname.lastname@example.org
Morning meetings second Wednesdays of each month, 10 a.m.-12 p.m. Please see our Facebook page for additional meeting times and locations.
Facebook: Hamilton County Moms Breastfeed
Indy Breastfeeding Moms
meeting, phone, email
Ali, Amie, Megan, Jillian, Jasmine, Ann, & Sara
Facebook: Indy Breastfeeding Moms
Morning Chapter Meetings: Second Friday of each month,10:15 AM
College Avenue Branch Library, 4180 N. College Ave.
Evening Chapter Meetings: Third Wednesday of each month, 6:00 PM
Nora Library, 8625 Guilford Avenue.
Topics Meetings: Third Friday of each month, 10:15 AM
First Mennonite Church, 4601 Knollton Ave.
Nursing Mom's Socials: First Friday of each month, 10:15 AM
First Mennonite Church, 4601 Knollton Ave.
Lawrence (East Indy) Chapter
meeting, email, in person
Indianapolis-Marion County Public Library LAWRENCE Branch Meeting Room:
August 6, September 17, October 1, November 19, December 17
ALL meetings will start at 6:00 pm
Panera, located at 9145 East 56th Street, Indianapolis, IN 46216:
September 3, November 12, December 3
ALL meetings will start at 6:00 pm
Southeastern Indiana Breastfeeding Moms
meeting, phone, social media, email
Cara (812) 212-9512 email@example.com
Breastfeeding USA Eastern Iowa Chapter
meeting, email, text, home visits
Natalie Goyette (319) 329-6875 firstname.lastname@example.org
Meetings are held at Birth, Baby & Beyond, 4330 Czech Square, Cedar Rapids, IA 52402. We meet the second Thursday of the month at 7 pm and the 4th Monday at 10 am.
North Iowa Chapter
calls, text, email, meetings, in-home help by appointment
Alissa Gomez-Dean (641) 512-6614 email@example.com
Wichita Kansas Chapter
phone, email, text
Chris Clark (316) 747-9652 firstname.lastname@example.org
Breastfeeding Moms of Ashland
meeting, phone, email
Rachel (925) 297-KIDS email@example.com
Meeting Info: First Saturday of the month, 10:00am
Central Kentucky Chapter
Elizabeth (502) 209-9513 firstname.lastname@example.org
Carroll/Baltimore County Chapter
meeting, phone, email
Brittany (410) 800-7048 email@example.com
Meeting information: Call or email for details
Visit us on Facebook
Montgomery County Chapter
meeting, phone, email
Beth (301) 326-4715 firstname.lastname@example.org
Chapter meetings are the third Tuesday of each month at Holy Cross Resource Center, 9805 Dameron Dr., Silver Spring, MD 20902. 6:00 pm
Silver Spring Area
Leah (301) 593-2082 email@example.com
Genesee County Chapter
Toi L. firstname.lastname@example.org
phone, email, meetings
Jennifer (269) 317-8581 Jennifer.email@example.com
Shannon (616) 295-1128 firstname.lastname@example.org
Greater Twin Cities Chapter
phone, email, meetings, home visits
Becca Morgan (320)-333-4496 email@example.com
Meeting information: (every other Wednesday, 7:30 pm, The Natural Family Center in Waconia, MN
Serving the Missoula, MT area
Amy L. (406)207-4020 firstname.lastname@example.org
Meeting information: Meeting every Monday from 10:30-11:30 at 714 Kensington Avenue, Missoula, MT 59801
Central NJ Chapter
phone, email, meetings
Jessica M. (732) 674-0348 email@example.com
Staten Island NY Chapter
meetings, home visits by appointment: please contact to schedule.
Christine (917) 498-5307 ChristineBfUSA@gmail.com
Facebook: Staten Island Chapter
Chapter meetings are held the fourth Thursday of the month. Staten Island Children's Museum, 9:15am - 10:30am, Please email to RSVP. Meeting is free and includes access to SICM exhibit space during the meeting.
phone, email, in-person, meetings
Brenda (315) 510-5760 firstname.lastname@example.org
Meeting Schedule Still Evolving, Please check our facebook page or email Brenda for up to the date information!
phone, imessage, email
Anna (919) 593-4681 email@example.com
Lake Norman Chapter
email, phone, text, meeting
Volunteer Breastfeeding USA Counselors: Rebecca, Kate, Brittany
East Mooresville meeting, 1st Tuesdays 10am-noon
Warmline: (704) 980-8238 -- call or text
Cinci Breastfeeding Moms
meeting, email, phone
Suzanne Please send text to (513) 226-9272 firstname.lastname@example.org
Krista (513) 377-6328
Chapter meetings are the third Thursday of each month.
Cincinnati Breastfeeding Mothers Yahoo! Group
Clintonville Breastfeeding Support Group (Columbus Area)
phone, text, meetings, email
Rachelle Lesteshen (614) 500-3862 email@example.com
Meeting Information: Third Thursday of every month at 6:30pm at CHOICE - Center for Humane Options in Childbirth Experiences 5721 North High Street Worthington, Ohio 43085
Visit our Facebook Group
Dayton Area: Wright-Patt Nature & Nurture Nursing Support Group
phone, email, meetings, in-person
Mary (937) 405-6103 firstname.lastname@example.org
Meetings: 3rd Tuesdays at 7pm (contact Mary for location)
Facebook: Wright-Patt Nature & Nurture Nursing Support Group
Central Oklahoma/Chickasha Chapter
phone, meeting, email
Jan (405) 222-0723 email@example.com
Meeting info: 3rd Tuesday of each month, 10 am at the Chickasha Public Library meeting room, 527 W. Iowa, Chickasha
Upcountry South Carolina Chapter
Carol: (864) 877-7431 ; firstname.lastname@example.org
Murfreesboro Mom-to-Mom Breastfeeding Support
Melissa (615) 567-3890 email@example.com
Orange County Chapter-Breastfeeding USA
phone, meetings, email
Erin Sanderson (409) 466-8303 firstname.lastname@example.org
Facebook Page: orangecountybfusa
Facebook Group: orangecountybfusa group
phone, email, classes
Bonnie (915) 490-3407 email@example.com
Meeting Info: Tuesdays from 10-11am at My Little Play Place in Waco.
Shenandoah Valley Chapter
phone, email, monthly meetings, free courses
Megan Hartless (540) 860-0567 firstname.lastname@example.org
Facebook Page: Breastfeeding USA: Shenandoah Valley Chapter
Facebook Group: Breastfeeding USA Shenandoah Valley Circle
Website: Shenandoah Valley Chapter
Tacoma Area Chapter
phone, email, meetings
Sarah Harding: (515) 201-6418 email@example.com
Morning Meetings: 2nd and 4th Tuesdays at 10:15 am (email for location)
Evening Meetings: 2nd and 4th Wednesdays at 7:15 pm (email for location)
Facebook: Tacoma Area Breastfeeding Moms
Whatcom County Chapter
phone, email, in-person
Elizabeth (360) 474-7286 firstname.lastname@example.org
phone, email, in-person
Katherine (608) 285-2650 email@example.com
Watch us grow! More chapters opening soon.
I recently spoke to a mother whose 1-month-old baby was born 4 weeks preterm. She was breastfeeding with a nipple shield, which she was given in the hospital, and she was confused by conflicting advice. Should she pump after feedings? Was her baby getting enough milk? How should she wean from the shield? This was her sixth breastfeeding baby but her first preterm baby and first time using a shield. She was emotional and unsure of herself. My answers below were based on the research described in my book, Breastfeeding Answers Made Simple.
Express milk after breastfeeding? As long as her baby was gaining weight normally (which she was), there was no reason to pump after feedings. A study of 54 mothers and babies compared babies breastfeeding with a nipple shield to those breastfeeding without it and found no difference in weight gain during the first 2 months of life. 1 Although one 1980 study found babies took 22% less milk at the breast with a shield,2 these mothers used thicker, rubber shields. As long as the baby is suckling effective, today’s thin, silicone shields do not appear to decrease milk intake during breastfeeding.
How to gauge baby’s milk intake. Weight gain is the best way to know a breastfeeding baby is getting enough milk. This baby was gaining well, so adequate milk intake was guaranteed. After feedings, other signs of milk intake include reduced feelings of breast fullness and milk seen in the tip of the shield.
Weaning off the shield. A hospital nurse told this mother to wean her baby from the shield by gradually cutting it away. This strategy made sense with rubber shields, but cutting silicone shields produces sharp edges that could irritate the baby’s mouth. A better strategy is to start the baby feeding with the shield and when the mother hears swallowing to quickly slip off the shield and slip in the breast. But I told this mother to be patient. Her preterm baby may not be ready to wean from the shield. One study found nipple shields increased milk intake in preterm babies having trouble suckling actively and staying on the breast.3 While not all preterm babies need to use a shield, I told this mother that for now her preterm baby may breastfeed better with it. The baby’s readiness to wean from the shield is as important as the mother’s readiness.
In general, should nipple shields be considered “friend” or “foe”? It depends. As 88% of the mothers in one study reported,4 when used appropriately, nipple shields can help preserve breastfeeding. Or—like any breastfeeding tool—they can be misused and undermine it. In some cases, weaning off the shield may be the right thing to do. In others, a mother should be patient and wean from the shield later rather than decrease her baby’s breastfeeding effectiveness or turn the breast into a battleground.
1. Chertok, I. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs 2009;18(21):2949-2955.
2. Woolridge, M. et al. Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev 1980; 4(4):357-364.
3. Powers, D., & Tapia, V. B. Women's experiences using a nipple shield. J Hum Lact 2004; 20(3):327-334.
4. Meier, P. et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact 2000; 16(2):106-114.
Just like in the fictional Minnesota town of Lake Wobegon, where “all the children are above average,” many parents believe there is something wrong if their breastfeeding baby’s weight isn’t above the 50th percentile. While it is human to want our children to excel, the assumption that babies at a higher weight percentile are healthier or somehow “better” reflects a basic misunderstanding of growth charts and what they mean.
The purpose of a growth chart is to plot a baby’s growth on a series of percentiles, with the average baby at the 50th percentile. What this really means in terms of weight is that out of 100 children, 49 will weigh less and 50 will weigh more. A weight that falls at a higher percentile is not “good” and a weight that falls at a lower percentile is not “bad.” By definition, there will be healthy children at every percentile. Some will be chunky and some will be petite, but their percentile does not necessarily reflect their overall health or growth.
A child at the 5th percentile is not necessarily growing poorly and the child at the 95th percentile is not necessarily growing well. That’s because growth can only be evaluated over time. For example, a preterm baby born very small will likely fall on a low percentile for weight at first, even when he is gaining weight well. Also, if during pregnancy a mother had high blood sugar levels, gained a lot of weight, or received lots of IV fluids during labor, her baby’s birth weight may be unnaturally high. In these situations, after birth a large baby may fall in percentiles to a weight closer to what his genes naturally dictate.1
But parents are not the only ones confused. A U.K. study2 examined both mothers’ and healthcare providers’ perceptions of growth charts, and found that many mothers worried about their baby’s weight gain between checkups and that both mothers and healthcare providers erroneously considered the 50th percentile a goal to be achieved. When babies fell below the 50th percentile, healthcare providers often recommended the mothers give their babies formula and solid foods to try to boost baby’s weight gain to reach this “desirable” percentile. The researchers concluded that healthcare providers need more training on how to assess the growth of breastfeeding babies and how to support breastfeeding rather than undermine it.
Normal growth means a baby is gaining weight at a healthy pace and growing well in length and head circumference. One point on a baby’s growth chart should never be considered in isolation but rather compared to other points. It’s a baby’s growth pattern over days, weeks, and months that provides an accurate picture of how breastfeeding is going. If a baby is growing consistently and well, his actual percentile is irrelevant.
If over time, however, his weight-for-age percentile drops, first it’s important to determine whether the chart is based on breastfeeding norms, as many are not. (Click here for the World Health Organization’s growth charts based on exclusively breastfed babies.) If the chart is based on breastfed babies and the baby’s weight-for-age percentile has dropped, this is a red flag to take a closer look and see if breastfeeding dynamics can be improved.
1. Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.
2. Sachs, M., Dykes, F., & Carter, B. Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies' weight charts. Int Breastfeed J 2006; 1:29.