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. New mothers should stay home with
their babies for as long as practical and take full advantage of
the 26 weeks maternity leave to which mothers have a right in Canada.
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. Not true. 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 did accept a bottle in the first
weeks of life 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
6 months of age when you start back at outside work, the baby quite
simply does not need to take a bottle. He can be fed solids off
a spoon just as any other 6 month old 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 5
or 6 months of age. The cup can be an open cup and does not need
to have a spout. Start with water as your baby may spill a fair
amount at first. If, however, he has not gotten the hang of the
cup by the time you must leave him, do not worry, he can take fluids
off a spoon, or the solid foods can be mixed with more liquid (expressed
milk, juice). 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 the 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, will 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 nursing
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. Not
true. Three or four good nursings during a 24 hour period plus a
variety of solid foods 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. Not true. 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 though 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.
5. Followup formulas (artificial milk for infants over 6 months
of age) are specially adapted to the needs of infants 6 to 12 months
of age. Not true. 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 which 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).
Some people will buy anything, it seems. But these toddler formulas
will soon be here. You can bet on it. Bottom line über alles.
6. The breastfed baby 4 months of age needs to be getting more
iron than can be provided by breastmilk alone. Not true. For the
baby 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.
7. The best way to assure the baby’s getting enough iron is to
give him infant cereals. Not true. 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 assure the baby is getting enough iron is to continue
breastfeeding, and introduce solid foods in a relaxed, enjoyable
way at the appropriate time (Handout #16 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 4 1/2
to 5 1/2 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 best source of 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.
Handout #17. What to Feed the Baby when the Mother
is Working Outside the Home. Revised January 1998
What to Feed the Baby when
the Mother is Working Outside the Home
Written by Jack Newman, MD, FRCPC
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