Breastfeeding FAQs: Solids and Supplementing

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it OK to give my baby breast milk and formula?

Although breast milk is the best nutritional choice for infants, in some cases, breastfeeding (or exclusive breastfeeding) may not be possible or an option. Your baby's health and happiness is, in large part, determined by what works for you as a family. So if you need to supplement, your baby will be fine and healthy, especially if it means less stress for you.

Babies who need supplementation may do well with a supplemental nursing system in which pumped milk or formula goes through a small tube that attaches to the mother's nipple. They also can be fed pumped milk or formula by bottle.

Some experts feel that giving bottles too early can create "nipple confusion," leading a baby to decide that the bottle is a quicker, better option than the breast. To avoid this, be sure that your little one has gotten used to and is good at breastfeeding before you introduce a bottle. Lactation professionals recommend waiting until a baby is about 3 weeks old before offering artificial nipples of any kind (including pacifiers).

If I need to give my baby formula, how do I start?

If you're using formula because you're not producing the amount of milk your baby needs, nurse first. Then, give any pumped milk you have and make up the difference with formula as needed.

If you're stopping a breastfeeding session or weaning from breastfeeding altogether, you can begin to replace breastfeeding with bottle feeds. As you do this, pump to reduce uncomfortable engorgement so you will not have problems with plugged ducts or mastitis. As you eliminate nursing sessions, your milk supply will decrease and your body will begin to adapt to produce enough milk to accommodate your new feeding schedule.

Starting your breastfed baby on formula can cause some change in the frequency, color, and consistency of the stools (poop). Be sure to talk your doctor, though, if your baby is having trouble pooping.

If your baby refuses formula alone, you can try mixing some of your pumped breast milk with formula to help the baby get used to the new taste.

Is it OK for me to give my baby the first bottle?

If possible, you should have someone else give your little one the bottle at first. This is because babies can smell their mothers and they're used to receiving breast milk from mom, not a bottle. So try to have someone else — such as a caregiver or partner — give a breastfed baby the first bottle.

Also consider either being out of the house or out of sight when your baby takes that first bottle, since your little one will wonder why you're not doing the feeding as usual. Depending on how your baby takes to the bottle, this arrangement may be necessary until he or she gets used to bottle feeding.

If your baby has a hard time adjusting to this new form of feeding, just be patient and keep trying.

When should I introduce solid foods and juice?

For babies who are exclusively breastfed, doctors recommend waiting until a baby is about 6 months old. But some infants may be ready sooner.

How will you know if your baby is ready? Babies who are ready to eat solids foods:

• are interested in foods (for example, they may watch others eat, reach for food, and open their mouths when food approaches)
• hold up their heads well, and sit up with little or no help
• have the oral motor skills needed to eat (meaning that they don't push food of the mouth but move it to the throat and swallow it)
• usually weigh twice their birth weight, or close to it

Wait until your baby is at least 4 months old and shows these signs of readiness before introducing solids. Babies who start solid foods before 4 months are at a higher risk for obesity and other problems later on. They also aren't coordinated enough to safely swallow solid foods and may choke on the food or inhale it into their lungs.

When the time is right, start with a single-grain, iron-fortified baby cereal (rice cereal has traditionally been the first food for babies, but you can start with any you prefer). Start with 1 or 2 tablespoons of cereal mixed with breast milk, formula, or water. Another good first option is an iron-rich puréed meat. Feed your baby with a small baby spoon, and never add cereal to a baby's bottle unless your doctor recommends it.

At this stage, solids should be fed after a nursing session, not before. That way, your baby fills up on breast milk, which should be your baby's main source of nutrition until age 1.

When your baby gets the hang of eating the first food, introduce a variety of other foods, such as puréed fruits, vegetables, beans, lentils, or yogurt. Wait a few days between introducing new foods to make sure your baby doesn't have an allergic reaction.

Experts recommend introducing common food allergens to babies when they're 4–6 months old. This includes babies with a family history of food allergies. In the past, they thought that babies should not get such foods (like eggs, peanuts, and fish) until after the first birthday. But recent studies suggest that waiting that long could make a baby more likely to develop food allergies.

Offer these foods to your baby as soon as your little one starts eating solids. Make sure they're served in forms that your baby can easily swallow. You can try a small amount of peanut butter mixed into fruit purée or yogurt, for example, or soft scrambled eggs.

Note: There is no benefit to offering fruit juice, even to older babies. Juice can fill them up and leave little room for more nutritious foods, promote obesity, cause diarrhea, and even put a baby at an increased risk for cavities when teeth start coming in.

When can I give my baby water?

In their first few months, babies usually don't need extra water. On very hot days, most babies do well with additional feedings. But you may want to offer your infant water, especially if your baby's pee is dark or your baby pees less often than usual.

Once your baby is eating solid foods, you can offer a few ounces of water between feedings, but don't force it. Water that is fortified with fluoride will help your baby develop healthy teeth and gums. If you live in an area with nonfluoridated water, your doctor or dentist may prescribe fluoride drops.