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The Nursing Mother's Diet Good Nutrition for You and Your Baby From Sylvia Brown with

Mary Dowd Struck, Updated July 19, 2009 About.com Health's Disease and Condition content is reviewed by the Medical Review Board A nursing mother produces 23 to 27 ounces of milk per day, containing 330 milligrams of calcium per quart. This requires an extra energy expenditure of at least 500 calories per day. Good nutrition is therefore just as important for you as it is for your baby. The quality of breast milk is only affected in extreme cases of deprivation, or by excessive intake of a particular food. But the quantity of milk depends very much on the mother's diet. Food absorbed by a nursing mother not only fulfills her own nutritional needs, which are greater during the postnatal period, but also enables her to produce milk. A woman who does not feed herself properly may still have a healthy baby, but it will be to the detriment of her own health. If you lack sufficient nourishment, your body will make milk production its first priority, and your needs will go unmet. It is just the same as it was during pregnancy, when the nutritional needs of the fetus were satisfied before those of the mother. In fact, the baby, who weighs only a few pounds, will receive nearly 1,000 calories per day in breast milk! What does it mean to feed yourself properly while nursing? We can compare a breast-feeding mother to a marathon runner-whose race will last twenty-four hours, not four. The Basics Increase your water consumption by one quart per day, so that you are drinking a total of 2.5 to 3 quarts. Nursing women tend to be thirstier anyway, especially during feeding sessions, because part of their water consumption goes directly to milk production. But don't overdo it: too much liquid also can reduce milk production. Increase your daily caloric intake to 2,500 calories: you can even eat more if you are planning to continue breast-feeding for more than three months (2,800 calories per day). But again, be careful: many nursing mothers are tempted by sweets. Stick to healthy foods instead! Eat more proteins. The basic rule is to eat I gram of protein each day for every pound you weigh. Spread your caloric intake over five "meals," breakfast, lunch, after- noon snack, dinner, and an extra snack during the evening. Each snack time is also an opportunity to drink water, eat a low-fat dairy product, and a piece of fruit. As your body is continually producing milk, it needs your caloric intake to be regular. Stay away from tobacco. Nicotine passes directly through breast milk to the baby. if you cannot control yourself, build in a gap of at least an hour between your last cigarette and your next feeding session, so that the nicotine in your system has a chance to decompose at least partially. Avoid regular consumption of alcohol. Alcohol passes through milk in less than an hour and if the baby consumes it in large quantities it can retard his growth. if you drink an occasional glass of wine or beer, save it for after a feeding session. Take no medication without first consulting a doctor. Most antibiotics, sulfa drugs, chemical laxatives, and all products containing iodine are contraindicated while you are breast-feeding. Other medications, taken over a long period, can also be dangerous.

Beware of pollutants. Like nicotine, pesticide residue easily passes through mother's milk. If you are nursing, stay away from insecticides (especially in airborne forms such as aerosols or coils). Try to use natural insect repellents such as citronella. Eat primarily unsaturated fats. Sunflower, corn, rapeseed, and olive oil provide fatty acids that are essential for building the baby's nervous system. Eat food containing vitamin B 9. In Western countries, the only vitamin really lacking in women's diets is vitamin B 9 (folic acid). Birth control pills accentuate a woman's vitamin B 9 deficit, and may also contribute to a vitamin B 6 deficiency. During pregnancy, folic acid is vital to the development of the baby's nervous system. Nursing mothers are well advised to continue taking their prenatal vitamins. Folic acid also can be found abundantly in asparagus, cabbage, corn, chick- peas, and spinach. Many other foods, such as wheat and orange juice, have been enriched with folic acid. Check the package labels. Take zinc supplements. According to a British study, pregnant and nursing women also often lack zinc. They should consume 15 to 20 milligrams per day. Zinc is found in eggs, meat, whole flour, and oats. Consume 1,200 milligrams of calcium per day. A balanced diet only provides 800 to 1,000 milligrams of calcium daily. Because nursing mothers need 1,200 milligrams, a calcium supplement will probably be necessary. Calcium needs can also be partly met from dairy products, raw vegetables, almonds, and hazelnuts. Do not rush to buy vitamin A supplements. People often talk about vitamin A supplements for nursing mothers, because their daily need rises from 1,000 milligrams to 1,300 milligrams. It is true that if the woman had a vitamin A deficiency during pregnancy, this problem may worsen after childbirth. But anyone who eats enough carrots, vegetables, butter, fish, and meat will absorb enough vitamin A. We hear a lot about foods that can irritate the baby-turnips, celery, watercress, citrus fruits, onions, cabbage, spices, leeks, cauliflower-by giving him gas or changing the taste of his mother's milk. For example, some people say that garlic increases milk production; others say it gives the baby gas. There is no universal rule. Moreover, different cultures prefer foods that others consider to be "bad" for nursing mothers. Each baby reacts differently to the foods his mother consumes. If your baby is particularly disturbed one day, try to remember what you have eaten in the past twenty-four hours. If one food seems suspect, eliminate it from your diet for a while. When nursing, observe your baby so you can eliminate from your own diet any food that seems to bother him. There exist nutritional supplements that are said to increase milk production. Their effects have not been proven scientifically, but they have a placebo (psychological) effect. Be careful, some of these supplements have a very high sugar content, and are therefore high in calories. Also, many midwives will tell you that fennel and beer increase milk production, and that parsley stops it.

Diet for a healthy breastfeeding mum Written for BabyCenter India

Approved by the BabyCenter India Medical Advisory Board What you and your baby need during breastfeeding What should I be eating? Vitamin and Iron supplements Drink plenty of water to help maintain your milk supply Watch what you eat and drink What about dieting during breastfeeding? What you and your baby need during breastfeeding Some of the calories required for breastmilk production are supplied by body fat reserves laid down during pregnancy. However, additional calories are needed over and above your pre-pregnancy intake to provide enough energy to supply the needs of your growing baby. As you start to wean your baby, your calorie needs will gradually return to pre-pregnancy levels.

Studies show that if you breastfeed your baby, you will reach your pre-pregnancy weight faster as compared to a mother who does not breastfeed.

The recommended dietary allowance for lactating mothers according to the Indian Council of Medical Research is as follows:

0 6 months 550 Kcal /day 7- 12 months 400 Kcal /day

However, recent research suggests that these figures are too high and that an extra 300-400 calories per day is enough for exclusively breastfeeding mothers during the first three months.

What should I be eating? Think of breastfeeding as continued motivation to follow the healthy diet you followed during pregnancy. Focus on eating whole grains and cereals, fresh fruits and vegetables, and foods that provide plenty of protein, calcium, and iron (and, as always, an occasional treat is fine).

Opt for nutritious snacks like yoghurt, stuffed idlis, poha sandwiches made with wholemeal bread filled with leafy greens. You could also try baked chicken nuggets, canned salmon, tuna, low fat cheese slices, steamed sprouts, paneer cubes, baked vegetables and fresh fruit. However, ensure that you limit your intake

of ghee as it just adds to your calories. Go easy on ghee-laden treats prepared by older family members.

Vitamin and Iron supplements If you took antenatal supplements during your pregnancy, it is wise to check with your doctor if you need to continue taking supplements. And if you do continue with a general vitamin supplement, remember that it can't make up for poor eating habits. Strive to eat a well-balanced, varied diet.

Drink plenty of water to help maintain your milk supply Apart from all these vital vitamins and minerals, it is very important for you to drink plenty of water to help maintain your milk production. Water is a major constituent of breastmilk. Therefore ensure that you drink at least 10-12 glasses of water every day. You can also consume fruit and vegetable juices, lassi, buttermilk, coconut water etc. in addition to water. This will help your body to produce the milk you need for your baby.

Watch what you eat and drink Substances like caffeine, alcohol, and other toxins can pass from your blood into your breastmilk, so excessive amounts should be avoided. Nicotine from cigarettesand drugs also pass into your breastmilk and should be avoided (your doctor can advise you on the suitability of prescribed medications).

Smoking and alcohol are detrimental to your babys health.You'll be able to work out if your child is sensitive to something you eat or drink, because she'll show her discomfort by being unsettled after feeds, crying inconsolably, or sleeping badly. If you have a strong family history of allergies to some food, and you notice your baby has developed an allergic reaction, then avoid that food while breastfeeding.

While some women swear that hot or spicy dishes upset their babies, trial and error may be your best guide, as food-induced irritability differs markedly from one baby to the next. If you find you can eat garlic chicken or a fiery vegetable curry without making your baby unhappy, then dig in. One note of caution, though -some common colicoffenders include broccoli, cabbage, onions and Brussels sprouts.

If you are used to having aerated drinks to quench your thirst it is best to avoid these while lactating as they contain just empty calories and no nutrition. You could instead substitute it with lassi, coconut water or nimbu pani. Elders may offer you traditional drinks prepared with specific herbs. Check with your doctor

before including these in your diet.

What about dieting during breastfeeding? Lose weight gradually by combining a healthy, low-fat diet with moderate exercise. Rapid weight loss may pose a danger to your baby because it possibly releasestoxins -- normally stored in your body fat -- into the bloodstream, increasing the amount of these contaminants that wind up in your milk.

Plus, breastfeeding helps to burn up the fat deposited during pregnancy and uses it for producing milk. A mum who breastfeeds burns a lot more calories than one who doesn't, which means most breastfeeding mothers can lose around 0.5 kg a month, simply because of the energy demands of producing milk. It is wise to monitor your weight gain. Remember to reduce your calorie intake when your baby switches over to other food items.

Do still count on taking 10 months to a year to return to your pre-pregnancy weight, though. If you do decide to cut down slightly on your food intake, wait until at least six weeks after your baby is born. Limiting what you eat in the early weeks of lactation may reduce your milk supply. Breast-feeding and Diet You need about 500 calories a day more than your prepregnancy intake if you breastfeed your baby. These additional calories, plus the calories available from the three to seven pounds you stored in pregnancy for lactation, supply enough calories to make milk. Once you reach three to seven pounds above your prepregnancy weight (including two to four pounds for the weight of your lactating breasts), let your weight guide you to the number of calories you should consume each day. Your activity level and the amount of milk you produce for your baby also affect your weight.

2006 Publications International, Ltd. It is important to get enough fluids when you are breastfeeding. In addition to extra calories, include extra protein for milk production, more calcium- and vitamin-rich foods, and more fluids than your normal diet. Here are some simple guidelines:

Continue to take your prenatal vitamins (unless your doctor tells you otherwise). Eat a varied, balanced, good-quality diet.

Pay special attention to fluids; drink enough to quench your thirst. Many moms drink a tall glass of milk or water while nursing.

Avoid junk foods and empty calories. Foods and Drugs to Avoid Every breastfeeding mother wonders if something she ate caused fussiness, gas, diarrhea, or a rash in her baby. While you can eat most foods without problem, some foods can cause difficulty. Cow's milk in the mother's diet may cause colicky symptoms in some babies. If this is a problem for your baby, she will draw her legs up toward her body and scream with gas pains after feeding. You can eliminate milk from your diet for four to seven days to see if the symptoms disappear. As your baby grows older, reintroduce milk into your diet because babies often outgrow this reaction to milk. If you eliminate dairy products from your diet, you need to talk with your doctor about a calcium supplement. Other foods that may cause problems for breast-fed babies include those that contain food additives and dyes, certain gas-producing foods (such as broccoli, cabbage, and beans), eggs, nuts, tomatoes, shellfish, chocolate, corn, strawberries, citrus fruits, onion, garlic, and some spices. To decide if a particular food upsets your baby, eliminate that single food from your diet and see if the symptoms disappear. If you consume food in very large amounts, this may cause problems for a breast-fed baby. A half gallon of apple juice or orange juice, very large amounts of fruit, a whole jar of peanuts, or any other food consumed in unusually large quantities may cause your baby to have diarrhea or gas. In the past, breastfeeding mothers were encouraged to drink beer to aid milk production. We now know beer does not increase milk production. We also know beer and other alcoholic beverages readily enter the breast milk in about the same concentration as your blood alcohol level. Since no safe level of alcohol has been established for the breast-fed baby, it is wise to strictly limit your alcohol intake or not drink at all. In addition, alcohol can inhibit letdown (the release of milk from the milk-producing sacs within the breasts to the milk ducts), so your baby does not get the milk he needs. Cigarette smoking and breastfeeding are not compatible. Heavy cigarette smoking may reduce milk production; increase the incidence of nausea, colicky symptoms, and diarrhea in the baby; and decrease the vitamin C content of the milk. Smoking near the baby increases his risk of many respiratory ailments, including pneumonia, bronchitis, and asthma. As in pregnancy, the best advice is to quit. Caffeine passes into breast milk and may cause your baby to have an upset stomach and be irritable. If you suspect caffeine affects your baby, eliminate coffee, tea, cola, chocolate, and other caffeine-containing products from your diet (or switch to decaffeinated products) to see if the symptoms disappear. Do not take any vitamin supplements or herbs other than your prenatal vitamins without consulting your doctor or a registered dietitian first. Almost every drug or medication makes its way into breast milk. Some medications appear to have no harmful effects on your baby, while others are most certainly not safe. Talk with your pharmacist or your child's doctor before you take any prescribed or over-the-counter medications-be sure the medications pose no problems for your baby. If you need to take any drugs, particularly on a regular basis, discuss this with your doctor. You may have to stop breastfeeding until all the drug has passed out of your system. There are some cases where a mother will not be able to breastfeed. Modern formulas have come a long way toward reproducing the benefits of breast milk. In the next section, we will show you how to bottle-feed.

How to Bottle-feed Publications International, Ltd. Knowing how to bottle-feed can spare your baby an upset stomach. Learn how to select a baby formula and how to prepare a baby bottle. Mothers have fed their babies formulas for years. In the past, evaporated milk was the main component of formula. Doctors would recommend various additions to it in an attempt to make the formula more complete. Many different types of baby formula are available. Formula manufacturers continually improve their products, trying to make them closer to breast milk. A number of special formulas are also available for babies with certain health problems. Most formulas use nonfat cow's milk as their base and source of protein. Many different fat sources are used: Soy, coconut, and corn are the most common. Various vitamins, minerals, and trace elements are also added. There is, however, no way to duplicate the antibodies found in breast milk. For babies with a milk allergy or intolerance, formulas are available with soy protein in place of nonfat cow's milk as the main source of protein. Babies with digestive problems or acute, severe diarrhea often need formulas that are very easy to digest and absorb. These formulas use casein as their protein source. They are usually used for only a few days, until the baby recovers from the diarrhea. Selecting a Formula All the milk-based formulas currently available are similar in composition and nutrient value, with only minor differences between them. Despite this, some babies seem to do better on one milk-based formula than on another. If your baby has gas, vomiting, or bowel problems with one formula, consult your doctor regarding a possible change in formula. Most formulas are available either with or without supplemental iron. The iron is necessary to prevent iron deficiency. The American Academy of Pediatrics recommends iron-supplemented formulas only. Through television and print advertising, formula manufacturers encourage use of their brand of formula. The American Academy of Pediatrics opposes this type of advertising because your doctor is best suited to help you decide which formula is best for your baby if you do not breastfeed. Formulas come in three forms: ready-to-feed, concentrate, and powder. All three forms contain the same protein, fats, and other nutrients. The type you select is a matter of price and convenience. The most convenient, but most expensive, is the ready-to-feed in individual baby bottles or quart cans. The powder and concentrate are less expensive but can be more of a hassle to use. The only difference between the three forms of formula is the water you need to add to the concentrate and powder forms. If your water contains fluoride, then you may not need to give your infant a fluoride supplement. If you use a ready-to-feed, then your baby may need the additional fluoride. Bottles, Nipples, and More Using formula means you need bottles, nipples, and other paraphernalia. There's really little difference between plastic and glass bottles except glass bottles break more easily. The size you select is a matter of convenience. And some parents find special bottle/liner systems handy. Nipples come in many different sizes and shapes. Some makers of nipples claim theirs are "more like

mother" because of their shape. What's really important is not what the nipple looks like in the package but how it works when your baby sucks on it. If you find a nipple that meets your baby's needs, stick with it. If your water supply is safe and clean, you do not need to sterilize or boil bottles and nipples. Clean them with hot, soapy water and then rinse and thoroughly dry them. Some parents put the bottles in the dishwasher. Mixing and Storing Formula With the concentrated and powdered formulas, you must add water before you use them. Except when told otherwise by your doctor, never add more water than the instructions say. Over-diluting formula on a regular basis leads to malnutrition. Again, if your water supply is clean and safe, you don't need to boil the water before you add it to the formula. As a general rule of thumb, if you can drink the water without problems, so can your baby. If you have concerns regarding water quality, check with your local water or health department, or discuss your concerns with your baby's doctor. If you mix one bottle of formula at a time, you can just add cold tap water to the powder, mix it well, and feed your baby. In areas with fluoride in the water, you won't need to give your baby supplemental fluoride. Avoid using hot tap water -- any lead in the plumbing is more likely to leach into hot water. You can safely refrigerate mixed or open formula for 24 hours. When you travel, the most convenient form of formula is the powdered type. You simply add water, and you're ready to feed your baby. You should be extremely cautious, however, if there is any question about water quality. Bottle-Feeding a Baby It isn't necessary to warm bottles of formula. Some babies will take the formula straight from the refrigerator. Obviously, giving a cool bottle of formula is a lot quicker and easier than trying to warm up a bottle when your baby is screaming. If you wish to warm the bottle, just hold it under hot running tap water. Then, shake it well to mix the formula, and test the formula to be sure it isn't too hot for the baby. Do not heat your baby's formula in a microwave oven. This method has too many potential dangers. When you feed your baby, always hold your baby and the bottle -- never prop the bottle. Your baby shouldn't lie down and feed. He should always be semi-upright or sitting up. Bottle propping causes four problemsincreased ear infections, increased cavities, feeding longer than necessary, and decreased emotional and physical satisfaction from being held. The nipple hole should be large enough that the formula drips out at a steady pace of two drops per second. A flow that's too slow may increase the amount of air your baby swallows. If the flow is too fast, he may choke. Regardless of whether you breastfeed or bottle-feed you will have to develop a feeding schedule for your baby. We will cover this in the next section. Infant Feeding Schedules and Burping No matter how you feed your baby there are additional considerations you will have to take into account. In this section, we will review feeding schedules and burping. Demand Versus Scheduled Feedings There is no consensus regarding which feeding method is best -- feeding at the child's demand or according to a schedule. If your schedule is flexible and you are willing to feed your baby frequently, demand-feeding

may be best. You feed the baby whenever he seems hungry. A potential problem is that your baby may get used to taking only small amounts of formula or milk frequently, so you spend a lot of time feeding him. Using a regular schedule may be easier -- since you know what times he will eat, you can organize your day around this schedule, and he can become accustomed to the schedule. Whichever method you use, it's important not to overfeed your baby. Once he loses interest in the bottle or breast, stop. Don't try to coax him into taking more. An infant generally doesn't need more than one quart of formula a day. Most breast-fed babies consume the majority of milk from a feeding in five minutes on each breast. Any sucking after that is usually for comfort. Burping Babies generally swallow some air as they feed, although breast-fed babies tend to swallow less air than bottle-fed babies. To minimize the amount a bottle-fed baby swallows, try to always keep the nipple full of formula as you feed. Regardless of the method of feeding, an air bubble may accumulate and make your baby uncomfortable. To prevent that distress, you should burp her at the conclusion of each feeding; you may also want to burp her at the midpoint of the feeding to prevent the buildup of too large a bubble. There are a number of common positions to burp a baby, and no one of them is the right one. You will eventually find the one that is most effective for your baby, although on some occasions, you may have to run through the whole repertoire of 2006 Publications International, Ltd. burping positions until you get results. However you decide to feed your baby, it is important not to These positions generally have in common putting some slight pressure overfeed. on the baby's abdomen -- by placing her against your shoulder so she faces backward; by sitting her on your lap, resting her midsection on your forearm or hand; or by laying her face down across your lap and then gently rubbing or patting the middle of her back. Remember to protect the area beneath her mouth with a cloth because she is quite likely to bring up some milk with the gas bubble; this is usually only a small amount and does not indicate a feeding problem. Some babies don't accumulate a large bubble or aren't made uncomfortable by one, so if your baby doesn't burp after several minutes of concerted effort, there is no point in exhausting both of you in a marathon burping session. Of course, you want to spare your baby any discomfort that might result from an air bubble, but if your burping efforts aren't successful, the worst that may happen is your baby noisily lets you know when the bubble is making her uncomfortable, at which point you can renew your burping efforts. So far our discussion around feeding and feeding option has focused on the mother. In the next section, we will explore how fathers can contribute. Infant Feeding and Fathers Publications International, Ltd. A new father can bottle-feed even a breast-fed baby. Research has shown that fathers can influence the diets of their families in some very important ways. In one study, 89 percent of mothers served infrequently or eliminated from the family diet entirely the foods the fathers disliked. In another study, 81 percent of mothers surveyed planned meals based on the food preferences of the fathers. As a result of such studies, nutritionists now urge fathers to recognize the important effect their food tastes have on the nutritional well-being of their families. Your food preferences and dietary habits are the first important way you are involved in feeding. You have

an essential role in achieving a nutritious, age-appropriate diet for your baby. During pregnancy, you and the baby's mother probably discussed how to feed your baby -- by breast or bottle. If the two of you decided breastfeeding was the best choice, your unswerving support during the time your baby is breast-fed is crucial. If you chose to bottle-feed, your acquiring knowledge about formula preparation and healthy feeding practices is necessary and valuable. Perhaps you and the baby's mother chose to breastfeed first and bottle-feed later or to combine the two feeding methods. In any case, your support and involvement with feeding your baby will help your baby and give pleasure to you. If your baby is breast-fed, you obviously cannot directly provide milk for your baby, although you can give him bottles of expressed milk if there are times when it is inconvenient or impossible for your partner to breastfeed. There are other important ways you can be helpful during feedings. You can bring your baby to his mother for night feedings and then tuck him back in bed later. You can burp the baby after feedings and take the opportunity to enjoy the quiet but alert time he has after feeding. Many breastfeeding mothers experience sore nipples, fatigue, and doubts about milk supply. Your encouragement and nurturing help are important. In fact, one study has demonstrated a relationship between the father's support of breastfeeding and its success or failure. Another important way you can help is to teach other family members about breastfeeding, so they understand and support this method of feeding. In the past, less was known about the benefits of breastfeeding than is known today, and feeding practices were different. If your baby is bottle-fed, you can help by actively sharing the feedings with his mother. Make it your responsibility to mix formula in the proper way and to ensure the feeding equipment is clean and functioning well. Always hold your baby when you feed him. He will begin to trust that you love him and are able to satisfy his needs. To provide for normal eye muscle development, hold him sometimes in your right arm and sometimes in your left. Hold him so his head is slightly elevated. Feeding in a flat position is associated with greater risk of middle ear infections. Discontinue feeding your baby when he indicates he is through. Burp him during and after feedings. The frequency of burping depends on how much air he seems to swallow. Whether your baby is breast- or bottle-fed, you can help by keeping feeding times calm. Run interference with the doorbell and the telephone. Anything you do to reduce tension is beneficial. When your baby is ready for table foods, you can be involved in many ways. You can help by making mealtimes pleasant. Tension during feedings diminishes appetite and disturbs digestion. Make an effort to indicate pleasure with the variety of foods you offer your baby even if the food does not appeal to you. As tempting as it might be, avoid using food as a reward for good behavior or a special accomplishment. Never offer your baby junk food or alcohol. Neither is part of a nutritious diet, and each replaces the foods your baby does need for growth and health. In addition, even small amounts of alcohol can be toxic to a young child. Your involvement with your child's mealtimes is important. You can have a significant effect on your baby's health, and your relationship benefits from the time you spend together. The decision to breastfeed is ultimately a personal choice that the parents will make by themselves. In fact,

you might find that you cannot make a final decision until you have tried breastfeeding after the delivery. Hopefully, the information in this article will help you make this choice.