Guest Author: Margareta Benković, M.Sc. Nutr.
Nutritionist at the Centre for Nutrition Counseling
Centre for psychological assistance of Association of women affected by cancer EVERYTHING for HER*
Breastfeeding contributes to establishing a close bond between mother and child, as well as to the healthy growth and development of the newborn. It reduces the risk of infections, positively affects the child’s cognitive development, and lowers the risk of allergies and high blood pressure. In addition to its positive impact on the infant, breastfeeding also improves the health of the breastfeeding mother. It reduces postpartum bleeding and stimulates the uterus to contract, returning it to its pre-pregnancy state. It also helps with postpartum weight loss and reduces the risk of developing breast and ovarian cancer.
Up to six months of age, breast milk is the only food that meets all the infant’s nutritional needs. However, even in the most developed countries, the prevalence of breastfeeding is not at a satisfactory level. This is why it is important to promote breastfeeding as the only adequate nutrition for infants and to encourage its continuation even after complementary feeding has started.
Health organizations recommend exclusive breastfeeding during the first six months of a child’s life, and afterwards, breastfeeding in combination with other foods, for as long as it has a beneficial effect on the health of the mother and child.
Breast milk
Breast milk meets all the infant’s nutritional needs, thereby enabling optimal growth and development. It contains a balanced amount of all necessary nutrients in an easily digestible and highly bioavailable form. In addition to macro- and micronutrients, breast milk also contains numerous immune components. They provide protection for the newborn, since it does not yet have a developed immune system. Unlike any other immunization, breast milk can adapt to the infant’s specific needs. Breast milk also contains more than 100,000 other compounds that change during the child’s development.
The main components of breast milk are proteins, fats, and lactose (milk sugar). They are synthesized and secreted from the epithelial cells of the mammary glands. The composition of the milk is influenced by the lactation stage, the infant’s gestational age, feeding stage, feeding frequency, degree of breast fullness, and the mother’s nutritional status.
Colostrum, the first milk, is secreted during the first few days after birth. Transitional milk refers to the milk secreted during the following two weeks, after which mature milk is produced. Compared to mature milk, colostrum is richer in proteins and minerals, but poorer in carbohydrates, fats, and certain vitamins. The concentration of proteins and minerals in colostrum gradually changes to match the infant’s development.
Milk also changes its composition during a feeding. At the beginning of a feeding, milk contains the highest proportion of water. The fat content increases over time, and the milk secreted towards the end of the feeding is the richest in energy. The energy value of breast milk varies significantly due to differences in fat content, but on average it amounts to 67 kcal/dL. Using breast milk as the gold standard, the caloric value of infant formulas must also be 67 kcal/dL.
The concentration of antioxidants in milk decreases during pumping and storage and varies depending on the storage method. To preserve optimal antioxidant effects, it is better to store breast milk in the refrigerator than in the freezer, and for no more than 48 hours. The antioxidant content of breast milk is sensitive to tobacco smoke; milk from mothers who smoke or are exposed to passive smoking contains fewer antioxidants.
Nutrition of breastfeeding mothers
Restrictions on the consumption of certain foods are mostly culturally conditioned; there is no scientific basis for them. Breastfeeding mothers who are not allergic and have healthy infants are not advised to avoid allergenic foods during lactation. The effectiveness of such avoidance in reducing allergies in infants has not been proven, not even in families with a hereditary tendency to atopic diseases.
Also, contrary to popular belief, there is no scientific evidence that the consumption of foods that cause bloating, such as cruciferous vegetables, legumes, or chestnuts, causes colic in infants. Eliminating them from the diet unnecessarily reduces its diversity and quality.
However, it is advisable to avoid raw foods such as raw fish, steak tartare, unpasteurized milk and dairy products, and mold-ripened cheeses, in order to reduce the risk of food poisoning.
As during pregnancy, the mother must continue with a quality diet during breastfeeding to ensure optimal milk production. Poor maternal nutrition will not reduce the nutritional composition of the milk but will reduce the total volume produced. If the breastfeeding mother’s diet is not nutritionally adequate, the body will draw the missing nutrients from the mother’s stores, thereby compromising her health. The infant draws all its nutritional and energy needs from breast milk, which the mother must replenish through her own diet. Therefore, during breastfeeding, energy and nutrient needs are increased.
Lactation requires an increased energy intake of 300 kcal during the first six months, and 400 kcal during the second six months, which is approximately equal to the recommended daily energy intake in the last trimester of pregnancy. In addition to the extra energy the mother needs to take in from food, it is estimated that another 100 kcal per day is mobilized from fat stores. The total energy requirement for breastfeeding is therefore about 500 kcal per day. The minimum daily energy intake that ensures successful breastfeeding is estimated at 1,800 kcal. In the mammary glands of a woman who exclusively breastfeeds during the first six months postpartum, an average of about 750 mL of milk is produced daily.
During breastfeeding, special attention should be paid to the adequate intake of essential fatty acids, especially omega-3s. Adequate intake is essential for the proper neurological and cognitive development of the child. The best source is oily fish (sardine, tuna, salmon), recommended one to two times per week. If this is not possible, fish oil or omega-3 fatty acid supplements can be taken.
A quality diet ensures sufficient vitamin and mineral intake, so supplementation is generally not necessary. However, although breastfeeding mothers do not have increased needs for iron, supplementation is often recommended, primarily to replenish stores depleted during pregnancy.
Fluid needs are increased during breastfeeding. Mothers are advised to drink at least 2–3 liters of fluids daily. It is important to note that drinking more than the recommended amount will not result in increased milk production. If the mother is not in the habit of regularly consuming fluids, it is recommended to drink a glass after each feeding. A good indicator of adequate fluid intake is urine color, which should be light and odorless. Coffee and other caffeinated drinks can be consumed in amounts of one to two cups per day. Since caffeine passes into milk, higher intake can cause insomnia and nervousness in the infant.
During breastfeeding, weight loss of more than 0.5 kg per week is not recommended, because in the process of losing weight, harmful substances stored in fat tissue are released and enter breast milk. Remember, the minimum caloric intake during breastfeeding is about 1,800 kcal. Therefore, if the mother needs or wants to lose weight, it is recommended to create a caloric deficit by increasing physical activity rather than by further reducing energy intake.
Complementary feeding
Infants acquire a sense of taste and smell long before they start eating solid foods. Eating habits are acquired already in the womb through amniotic fluid, during breastfeeding, and when introducing new foods.
Exclusive milk feeding, whether breast milk or formula, becomes limited as the infant grows and develops. After six months of life, it is no longer sufficient to meet all nutritional needs. This is why complementary feeding, introducing foods into the child’s diet, begins at this stage. Complementary feeding refers to any food that is not breast milk or infant formula.
There is no specific day or week of age for starting complementary feeding. This moment is assessed based on the infant’s physiological, immunological, and neuromotor maturity. Most infants are ready for complementary feeding between the 17th and 26th week of life. Starting complementary feeding later may result in difficulty accepting new tastes and solid foods, or even refusal to chew. Introducing new foods into the child’s diet instills healthy attitudes toward food and nutrition for life.
There are no specific recommendations for which food to start with. The choice depends on the region, tradition, and family dietary habits. It is recommended, however, to start with easily digestible foods such as banana, carrot, chard, potato, rice, chicken, hake, etc.
In our country, a child’s first food is often fruit, which the child will more easily and willingly accept. Acceptance of a new food can be improved if it is offered alongside those the child is already accustomed to or likes. With persistent offering, most children will accept bitter and sour tastes. This reduces preference for sweet and salty foods, potentially lowering the risk of obesity and hypertension in adulthood. To get the child to accept it, a food needs to be offered repeatedly, 8 to 15 times.
Each new food should ideally be given in small amounts and in a form already familiar to the child, with the quantity gradually increased over the next few days. At this stage, it is important to monitor the child’s behavior and note any changes in skin or stool. Foods should be introduced gradually and individually—one new food every 2–3 days, so that any pathological reaction (including allergy) can be detected in time. As more foods are introduced, the child’s diet becomes more nutritionally rich, and the child gradually becomes accustomed to new tastes and textures.
The feeding process is important for oral-motor development, especially between 6 and 10 months of age. It is therefore important to change the texture of complementary foods. From completely pureed foods (smooth purees), gradually move to thicker and lumpier foods, and by the 10th month, it is recommended to introduce food in small pieces.
Cow’s milk as the primary milk drink is not recommended in the first 12 months, but in small amounts, especially in fermented form, it can be added earlier to complementary foods.
The consumption of honey in infancy is not recommended due to the possibility of contamination with Clostridium botulinum spores (unless it is a sterilized product). Juices and sweetened teas are also not recommended. Water and fruit should be the sources of fluids.
If the origin of raw ingredients is known, meals are better prepared at home, but if not, it is recommended to buy ready-made purees. Their quality is strictly monitored, making them safer for health.
Contrary to popular belief, delaying the introduction of potentially allergenic foods does not reduce the incidence of allergies. Allergenic foods (eggs, gluten, soy, fish, nuts) can be introduced along with all other foods. The exception is infants who have developed an allergic reaction to some food from the mother’s diet before starting complementary feeding (e.g., cow’s milk). In such cases, foods such as eggs and peanuts must be given for the first time under medical supervision.
It is believed that infants have an innate sense of satiety. It is therefore important for parents to recognize signs of hunger and fullness from the earliest age and to start feeding when the child is hungry, but also to stop when it is full. This creates a healthy lifelong habit. It is also important to include the child in family eating habits from the beginning, feeding them at the table during family meals. This instills the importance of the social component of eating. If some of your questions weren’t answered, contact us by pressing the button below.
*Association of women affected by cancer EVERYTHING for HER created the Centre for psychological help for women affected by cancer. Through educational workshops as well as individual and group work with users, dietary topics take a significant place which is why the centre for diet counseling has been formed so that affected women can receive advice from a nutritionist about an individual diet system, adjusted to personal needs and possibilities.