This title is likely a shocker to some of you. Before I start, I want to reassure everyone that I’m still a huge breastfeeding supporter. This article is about a growing trend that I have seen among US breastfeeding Mammas (mostly among middle to upper class suburban Moms … if I’m being totally honest). This is the trend for continued “high frequency breastfeeding” among older infants. This means nursing an older infant (think 8 – 15 months) multiple times a day, sometimes instead of offering solid foods.
I can totally understand this! We doctors and lactation specialists have done a fantastic job getting out the message the “breast is best”! Breastfeeding rates in the US are slowly but continually rising! Many Moms, who just want to give their babies the very best, continue breastfeeding long after solid foods are introduced. In general, this is all great news! But I get a little concerned when older infants (12 months or so) are still receiving the majority of their calories from breast milk.
My concern comes from a professional nutrition standpoint. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for roughly 6 months, and then continued nursing until at least 12 months. This is where most people and pediatricians focus. But it’s also equally as important to introduce solid foods that provide iron and zinc at 6 months and to gradually increase the amount of solid foods as the infant grows. This is because there is not much iron in breast milk, and breastfed infants have used up their own iron stores by 6 months, meaning they HAVE to get iron from their solid foods – this is normal. (I talk about this a little bit in my articles about how a Nutritionist buys baby food.) This means – if an older breastfed baby isn’t given solid foods that meet his iron and zinc needs, he’ll be at high risk for lots of complications that can be caused by iron and zinc deficiency, including anemia and poor growth.
This is the scenario when “breast is no longer best”. I have seen several patients who are breastfeeding mothers that don’t introduce any solid foods until 8 or even 9 months. Then, baby begins with applesauce and bananas (no iron, zinc or protein!), and is still only eating a few tablespoons of these foods by 1 year. It’s this feeding pattern that makes me nervous.
In one of those magical-clouds-parting moments, I had the opportunity to write an editorial for the medical “Journal of Pediatrics” about a research study that documented this very thing! (1). The study was led in Cincinnati and studied the diets of older breastfed infants (aged 6 – 12 months) in 3 cities around the world: US (Cincinnati), Mexico (Mexico City) and China (Shanghai). The researchers measured how much breastmilk infants drank and they measured the “Minimum Dietary Diversity” (MDD) of the infant’s diet (2). Minimum Dietary Diversity is a tool invented by the World Health Organization (3,4) that assigns a score to infants’ diets – the more recommended foods baby eats, the higher their score.
The study found that the US infants had the lowest Minimum Dietary Diversity scores (bad…). This was true whether they were still breastfeeding a lot or just a little by 12 months. Additionally, the US infants’ diets were really low in high-protein foods and meat. These are the very foods that are likely to provide that needed iron and zinc. The last finding was the most disturbing to me: Of the US 1-year olds who were still nursing frequently, over 70% failed to meet dietary diversity recommendations…. Yikes … that’s really bad. These infants are at great nutritional risk!
It’s not their parents’ fault! How many of you remember your 8 or 12 month pediatric appointment? The doctor usually asks if you’re still breastfeeding. Yes? That’s great! (and it is!). But, if baby is not underweight, then there are usually no follow-up questions about if solid foods have been introduced? what type of food? How often is it offered? How often are iron or zinc-rich foods offered? These are equally important questions!
But now you do know! My goal in life is to increase parents’ and pediatricians’ knowledge so we can keep more of our babies healthy. I hope this article was helpful!
Read more about great baby food options here . Does this article strike a chord with you? Tell me about it in the comments.
xo Dr. Young
References:
1. Young, B. E., and Krebs, N. F. (2015) Infants’ Dietary Diversity Scores: United States Breastfed Infants Fall Short. J. Pediatr.
2. Woo, J. G., Herbers, P. M., McMahon, R. J., Davidson, B. S., Ruiz-Palacios, G. M., Peng, Y. M., and Morrow, A. L. (2015) Longitudinal Development of Infant Complementary Diet Diversity in 3 International Cohorts. J. Pediatr.
3. Arimond, M., and Ruel, M. T. (2004) Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J. Nutr. 134, 2579-2585
4. Organization, W. H. (2008) Indicators for Assessing Infant and Young Child Feeding Practices. Part I: Definition. World Health Organization, Washington DC
Hello Dr Young
LOVE love your website and the various articles on it thank you for this 🙂
Am a mum to a 2 year old exclusively BF for 6 months then continued BF alongside solids and we are still continuing our BF journey together despite my return to part time employment. My little one does still feed several times a day on my days off but she also eats solids though the amount and volume varies from meal to meal. I do try to give her cereals and food that contain iron. Her weight has been more or less the same on the chart sitting on the 45-50th % do I need to be concerned at this stage?
Thanks
Hi Anita – thanks for the kind words! Honestly, I wish I could give you a detailed answer, but I just can’t without knowing much more detail about your little girl. But I think it’s just wonderful that you two are still nursing! And as long as you are strategic about getting those dietary sources of iron and zinc into your baby – then you should be fine! Here is a video that review some good choices. If you are worried at all, then talk to your Dr about it – that is what they are there for! It sounds to me like you are doing a great job 🙂 Keep up the great work!
Oh my goodness, I’m so glad I found your site! I am a mama of 6, the youngest 3 months old, the oldest 16! I nursed 5 babies for 2+ years each and this little darling is needing formula and pumped milk-which is a first for me (she has laryngomalacia which contributes to difficult feeding she was already hospitalized for FTT so formula has become a great friend of ours!), so happy fault that that led me to your site! I think what you are saying is 100{d3431cee00683dd1c43a4eb0fdbd2aadf61cae39541cb3bcdd241b07539079d2} true looking back on my 5 kiddos I was of the belief that they didn’t need solids until 8-12 months because I read that in a lot of pro-breastfeeding literature and I can tell you that had I read what you have said, it would have helped a great deal! My 4th was iron deficient and had some other medical/dental issues, but I was stubborn and reading the wrong materials thinking he really didn’t need what they told me. Many of my kids have pretty plain diets and are very picky now. Not sure if it’s all related, but I wouldn’t be surprised. I would not trade the time I spent with them nursing, but I do wish I had felt more freedom to transition earlier. I actually thought delaying solids was healthier. It would have meant a great deal to my mental and physical health and I think to their’s too if I had known they needed the solids! So, on my 6th, our little “Bridget” I am thrilled to have your site to guide me! And I have the opportunity now to share that info with younger mamas and my own children when they start raising a family. Thanks so much!
I am so touched by this! I can NOT believe you took the time to write such a thoughtful comment with 6 KIDS! You are a saint and a blessing 🙂
How late jumping on the iron/zinc bandwagon is too late? My pediatrician told me to do either iron fortified cereal, meat, eggs or beans to get iron at our 6 month appt. My son is now almost 8 month and eats anything I give him. But I’m 1) just now realizing when I give him finger foods he only actually eats about half of it and 2) I just watched your video about shopping for baby food and now I’m worried I’ve done damage by not giving him enough iron. I had read that “food before one just for fun” so I wasn’t stressing. I mostly feed him what I eat which is lean meat and green veggies but it never occursd to me lean meat has less iron. Anyway, I’m not sure if now at almost 8 months is too late to try and up my iron and fat content game. Though I’m not as worried about fat because I give him full fat dairy options and he nurses a lot.
Hey Catherine! It’s never too late! I am sure he is fine. First, your pediatrician will probably test for anemia at 12 months. You can always focus on iron-rich foods once a day finding something he likes. Super sources are egg yolks, meat, and liver. So if he loves egg, give him an egg every day for a while. If he shows any signs of iron deficiency (talk to your Dr), then you can always have him tested. But that test involves a blood draw, so I never recommend it “just in case”. If he eats anything you give him, then just start focusing on iron now and don’t worry 🙂