Nutrition in the first 6 months of life plays a critical role in the growth as well as the development of an infant. Breast milk is considered as “Liquid Gold”. It provides complete nutrition during the first 6 months meeting adequate calories, protein, and fat as per recommended dietary allowance (RDA). In addition, breast milk has the appropriate amount of calcium, phosphorous, iron, magnesium, zinc, and other micronutrients.
As per the World Health Organization (WHO), it is recommended to give exclusive breastfeeding till 6 months of completed age and it should be continued till 2 years. There is no need to give even water in the first 6 months. Water (87%) contributes to the major composition of human breast milk followed by lactose (7%), fat (3.8%), and protein (1%).
It is proven that poor nutrition in the first 6 months of age is associated with an increased risk of infections like diarrhea, pneumonia, and ear infections as well as an increased risk of death in the first 5 years of age. Poor nutrition also has long-term impacts on physical and mental development, early onset diabetes and obesity, and increased chances of autoimmune diseases. Optimal breastfeeding could save over 8 lakh children under the age of 5 years each year.
Do’s and don’ts for breastfeeding mothers
Breastfeeding mothers generally require more calories and protein. An additional 350 to 400 kcal/day and 15 to 20 g protein per day is recommended during this period. Iron and folic acid supplementation are continued during the postpartum period especially important among the Vegan population. Multivitamins and calcium supplementation will ensure adequate nutrition during this period. Generally, women should not limit or avoid specific foods while breastfeeding. Health care providers should ensure mother should intake enough fluids (3 to 4 litre/day), proteins (dairy products, meat, peas, pulses, soybean, etc), whole grains, legumes, starchy and non-starchy vegetables, and fruits. Certain foods which increase milk production are fenugreek seeds, spinach, sesame and poppy seeds, orange masoor dal, garlic, methi, eggs, ajwain, and paneer.
Caffeine intake should be minimized during this period (maximum of 2 to 3 cups/day). Smoking, aerated drinks, and sodas are to be avoided. Fish that are high in mercury like bigeye tuna, surmai, marlin etc. should be restricted from the diet. As per US CDC, refraining from alcohol is the safest option, occasional drinking is likely to be safe if you limit the amount and know the timing (alcohol can stay in your blood 2 to 3 hours post-drink). Frequent and excessive alcohol intake during breastfeeding leads to an increased risk of disrupted sleep and cognition delay at a later age in children. As a mother’s diet during breastfeeding influences her child’s diet later in life, they should limit their intake of foods that are high in added sugars and processed fats (junk food).
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Human breast milk is unique to meet the needs of the baby. Its composition is dynamic, and differences can be seen among mothers, different age groups, gestational age at birth, and maternal diet. Human breast milk composition changes in the first few couple of weeks after birth. Colostrum is secreted in the first few days contains higher protein and is rich in anti-infective factors like immunoglobulins and lactoferrin. After colostrum, transitional milk is produced for up to 3 weeks, which contains more fat and lactose. Mature milk is secreted from approximately 3 weeks after birth, and composition remains pretty stable till 6 months of age. Breast milk composition also changes during each nursing session. Foremilk is secreted initially, which contains higher lactose and quenches the baby’s thirst, and milk secreted later, hindmilk, contains more fat and improves weight and growth. Maternal diet influences the fatty acid and water/fat-soluble vitamin composition of human milk. There is not much impact on maternal diet on calorie and protein content.
What is the alternative to breast milk?
In situations where mother milk is insufficient or not possible to give breast milk, alternative feeding is the use of milk substitutes like infant formula if prescribed by your doctor. Cow’s milk or buffalo milk is to be avoided in the first year of age due to increased protein and fat content. Certain factors are unique in human breast milk including growth factors, enzymes, anti-infective factors, bioactive agents, immunoglobulins, and essential fatty acids which help in better somatic growth, improved immunity, and improved neurodevelopmental outcomes. As the days progressed important factors like nucleotides, docosahexaenoic acid (DHA) and probiotics were added to infant milk formula. Efforts have been made to produce infant formula identical to breastmilk, but it is impossible to replicate it.
Breast milk lacks a couple of Vitamins, namely Vitamin K (given at birth for all neonate) and Vitamin D. Babies who are on exclusive breast milk feeding will require only Vitamin D supplementation till 1 year of age.
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In conclusion, breast milk reigns supreme as the gold standard for infant nutrition in the first six months of life. Its unique composition provides unmatched benefits for growth, immunity, and neurodevelopment. While efforts to mimic breast milk’s benefits continue, its complexity remains unparalleled. Prioritizing breastfeeding is crucial for promoting optimal health outcomes and laying the groundwork for a healthier future.
(Author: Dr. Srikanth Kulkarni, Consultant – Neonatology and Pediatrics, Rainbow Children’s Hospital, Bengaluru)
