Questions that keep coming up about feeding

The first months bring questions that recur in almost identical form for every mother, and advice that arrives from everybody.

This article works through those questions one at a time, and says what published guidance states, what remains unclear, and what has no basis.

"My milk is not enough" — the most common sentence, and the one that usually ends in a decision

This is the sentence behind most early weaning decisions, and it is usually said at exactly the point when supply is still settling.

The mechanism is worth explaining, because understanding it changes the decision.

Milk production works on supply and demand. Milk removed from the breast signals for more to be produced; milk left in place sends the opposite signal. So frequent feeding and effective emptying are what raise production — not food and not drinks.

Which explains why adding a formula feed out of anxiety about supply actually reduces supply: the baby feeds less, the breast empties less, the signal falls — a loop that confirms the fear it started from.

And several things get misread as low supply: that the baby feeds often (normal — breast milk digests quickly), that the breast no longer feels full (this happens as production settles), or that the baby cries (crying has many causes).

The indicator actually followed is not the mother's impression — it is the baby's growth and nappy output, assessed by a paediatrician.

Dr Rana says the question reaches her in a different shape: "What do I eat so that my milk increases?" — "and sometimes she is waiting for me to name a magic food or a particular drink."

The answer is not a food: "The truth is that we look at the bigger picture. Is the mother eating enough, and eating a balanced diet? Is she drinking fluids properly? Is she getting a chance to rest? And how is the feeding itself going?"

And here is the line past which it stops being a nutrition question: "We don't judge the amount of milk from the mother's impression alone, and if there is real concern about the feeding or about the baby's growth, then an assessment by the paediatrician or a lactation specialist matters."

"How does what I eat affect my milk?"

The honest answer is that the effect is smaller than people imagine in some respects and larger in others.

The composition of breast milk is largely protected even when the mother's diet is not ideal — the body draws on her stores to maintain it. That has two faces: the milk stays nourishing, but at the expense of the mother's own reserves, which is precisely what makes a breastfeeding mother's own nutrition a matter for her health.

Some specific nutrients do vary in milk according to the mother's intake, certain vitamins among them, and that is followed clinically according to the case.

"Does a breastfeeding mother need to eat more?"

Yes — and this differs from pregnancy.

Producing milk itself costs energy, and the requirement during full breastfeeding is higher than in pregnancy. That surprises a great many people, because all the attention is concentrated on the pregnancy itself.

The practical problem is that this period is the hardest for preparing food: broken sleep, no time, and the baby first. The result is that many mothers eat less, faster and more poorly at exactly the point when their requirement is highest.

There is an article devoted to this: Postpartum nutrition — the mother in the first six months.

"I want to lose weight — when do I start?"

This is the second most repeated question, and it usually arrives early.

Dr Rana does not say no, and she says why: "We can pay attention to your weight, but we are not going to start with severe deprivation while your body is already in a stage that needs nourishing and recovering."

And the shape she works in: "We look at your food and improve its quality, we adjust the amounts gradually according to your case, and we try to make a change you can keep going with — without harsh regimes or promises of rapid loss."

And the sentence that closes the whole argument: "She is not being asked to choose between looking after her own health and feeding her baby. What is needed is a plan that takes account of both."

"Should I drink a lot of water so my milk increases?"

Hydration matters, and a breastfeeding mother feels thirstier, which is normal.

But drinking beyond what the body needs does not increase milk production. Production is determined by demand, as above. Drinking to thirst is sufficient; exceeding it adds nothing.

This myth is mostly harmless, but it draws attention away from the thing that genuinely matters: the number of feeds and effective emptying.

"Fenugreek increases milk"

Here we need to be precise.

Fenugreek and other herbs have long been used in Egypt and in many countries as galactagogues. Some have been studied, and the overall picture remains limited and not sufficient to be stated as a recommendation.

So: not a myth in the full sense, and not an established fact. The important distinction is that relying on them instead of the thing that does work — frequent feeding and effective emptying — is where harm can come in.

And any herb taken regularly should be mentioned to a doctor, because "natural" is not the same as "without effect".

"The baby has colic — should I cut something out?"

Colic in the early months is very common, with multiple causes, many of which have nothing to do with the mother's food.

Mothers excluding whole food groups — dairy, legumes, brassicas — happens constantly and often by family decision, and the usual result is that the mother's food becomes poorer at the point when her requirement is highest, without the colic improving.

There are genuine cases of allergy or intolerance in an infant, and those are diagnosed clinically and followed, rather than determined by trial and error at home.

Dr Rana describes the loop as she sees it: "Every time the baby cries or has wind, the mother starts asking herself 'what did I eat wrong?' — so she cuts out dairy, and legumes, and vegetables, and spices, and after a while she finds the list of what she eats has become very small."

Her rule is explicit: "Not every episode of wind or crying in a baby means the mother ate something wrong. We do not routinely exclude whole food groups out of fear alone."

And when is there genuinely a reason? "If there are recurring symptoms, or a real suspicion of an allergy or of a problem connected to a particular food, then we assess the case with the child's doctor and decide whether an intervention is actually needed."

So exclusion is a decision taken after an assessment, not a precaution taken before one.

"When do I start solid food?"

The World Health Organization recommends exclusive breastfeeding for the first six months, and thereafter the introduction of appropriate complementary foods alongside continued breastfeeding to two years or beyond.

The American Academy of Pediatrics, in its policy statement on breastfeeding, recommends in the same direction and supports continued breastfeeding alongside the introduction of complementary foods.

So six months is not an arbitrary number, and introducing food earlier does not "strengthen" a baby — the digestive system and the ability to swallow are still developing.

"What do I start with?"

The WHO has guidance devoted to complementary feeding for infants and young children, and it stresses a practical point: complementary foods must be rich in the nutrients whose requirement rises at this stage — iron above all, because a baby's own iron store begins to fall after six months.

Egyptian food offers good options here: boiled mashed lentils, egg yolk, finely minced meat or chicken, and mashed vegetables. These are things cooked at home, not products.

"Breastfeeding prevents pregnancy" and "my period came back so my milk is no good"

Two common sentences, both needing care.

Breastfeeding does delay the return of fertility in many women, but that depends on specific conditions — exclusive and frequent feeding, a particular age of baby, and periods not having returned — and relying on it as contraception without those conditions leads to unexpected pregnancies. This is discussed with a doctor rather than assumed.

And the return of periods does not make milk "no good". The milk remains nourishing, and some women notice a temporary change in volume around a period, which passes.

Introducing the foods associated with allergy

This is an area where the advice changed in recent years, and that is worth saying.

The older idea was to delay foods associated with allergy — egg, peanut, fish — until later. Research done subsequently changed that direction, and current guidance discusses introducing these foods in their time alongside other complementary foods rather than postponing them, because postponing does not reduce allergy and may do the opposite.

The clear exception: a child with a known allergy or a strong family history is handled individually by a paediatrician.

Honey before one year — the one rule in this article with no exception

This is the most important point in the whole piece.

Honey may contain spores of a particular bacterium, and an infant under one year has a digestive system not yet able to prevent them growing, which can cause a condition called infant botulism. Health guidance therefore states that honey should not be given to any child under twelve months — in any amount, in any form, and however pure or local the honey is.

This needs saying plainly, because honey is offered to small babies in Egypt out of affection: on a dummy, with herbs, or as "something sweet". The intention is kind and the risk is real.

And a practical point: food starts mashed and coarsens gradually over time. A child kept on purées for a long stretch is slower to learn to chew, and that shows up later as a refusal of solid food.

In the Egyptian context: aniseed, caraway and tea

Herbs are offered to infants for colic almost as a routine. What is worth knowing is that a baby under six months needs no fluids other than milk — not water and not herbal drinks — and those fluids take up space in a very small stomach and reduce feeding.

Tea in particular is an important point: it is given to children in a great many households, and it contains compounds that reduce iron absorption. And a child in the first and second year is precisely at the stage where iron requirement is high and the store is falling. So the habit works against the single most important thing at that stage.

And instead of sugar and honey in drinks, food itself provides natural sweetness: banana, mashed dates after the first year, and seasonal fruit.

Worth remembering

Milk production works on supply and demand, so frequent feeding and emptying are what raise it — not food and not drink.

A breastfeeding mother's energy requirement is higher than a pregnant woman's, at the point when preparing food is hardest. And colic is rarely resolved by excluding things from a mother's diet.

Six months of exclusive breastfeeding is a recommendation of both the WHO and the American Academy of Pediatrics, and complementary foods after it need to be rich in iron.

And no honey before one year — the one thing in this article with no exception.

As Dr Rana puts it: "Don't let the breastfeeding months turn into a long list of forbidden foods. A breastfeeding mother needs to be well fed herself."

If you want follow-up on breastfeeding or on introducing food: pregnancy and breastfeeding nutrition or book an appointment.

And there is an article on the child who refuses food later on: the child who will not eat.