This is not an
information sheet on all the ins and outs of working outside the home
and breastfeeding. This sheet provides information on how your baby can
be fed when you are not with him. It is addressed in particular to the
mother who is returning to paid work when the baby is about 6 months of
age or older. Mothers in Canada have the right to 52 weeks maternity
leave. You should take full advantage of this time if it is at all
possible. Remember that there are costs to returning to outside work
(transportation, clothes, daycare) that may cancel any benefit of
increased income. If you cannot take a full year, take at least 6
months, better 7 months (from the point of view of ease of continuing
breastfeeding while away from your baby). Your baby will never be this
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
Babies must learn to take a bottle so that they can be fed when the mother is not there.
Not true. Why not an open cup? It is true that some exclusively
breastfed babies will not take a bottle by 2 or 3 months of age. Most,
who have not taken a bottle, and even some who once did accept a bottle
will not take one by the time they are 4 or 5 months of age. This is no tragedy,
and there is no reason to give a bottle early so that the baby knows
how. If your baby is refusing to take a bottle, do not try to force
him; you and he may become very frustrated and there is just no need to go through all this.
If the baby is at least 6 months of age when you start back at outside
work, the baby quite simply does not need to take a bottle. If he is
even 3 or 4 months, he does not need to take a bottle. He can be fed
liquids or solids off a spoon and by 6 months of age he can be taking
enough so that he will not be hungry during the day. Furthermore, he
can start learning to drink from a cup even by 1 day of age. The cup
can be an open cup and is best not to have a spout (a “sippy” cup is,
essentially, a bottle). If, however, he has not got the hang of the cup
by the time you must leave him, do not worry, he can take fluids off a
spoon, or his solid foods can be mixed with more liquid (expressed
milk, water). Obviously, if the baby is to be taking a fair amount of a
variety of foods by 6 months of age, he may need to be started on
solids by 5 months of age. However, some babies prefer to wait for
their mother in order to drink something. This is fine; many babies
sleep 12 hours at night without drinking or eating at all.
But getting the baby to take a bottle surely won’t hurt.
Not necessarily true.
Some babies do fine with both. The occasional bottle, when
breastfeeding is going well, may not hurt. But if the baby is getting
several bottles a day on a regular basis, and, in addition, your milk
supply decreases because the baby is breastfeeding less, it is quite
possible that the baby will start refusing the breast, even if he is
older than 6 months of age.
Babies need to drink milk when the mother is not at home.
Not true. Three or four good breastfeedings during a 24-hour
period plus a variety of solid foods in goodly amounts gives the baby
all he needs nutritionally, and thus he does not need any other
type of milk when you are at your outside job. Of course, solid foods
can be mixed with expressed milk or other milk, but this is not
- If the baby is to get milk other than breastmilk, it needs
to be artificial baby milk (infant formula) until the baby is at least
9 months of age.
Not true. If the baby is breastfeeding a few times a day and
getting fair quantities of a variety of solid foods, infant formula is
neither necessary nor desirable. Indeed, babies who have not had infant
formula before 5 or 6 months of age often refuse to drink it because it
tastes pretty bad. (If you want to convince yourself of how little we
know about breastmilk, ask yourself why it is that, although breastmilk
and infant formulas have the same amount of sugar, breastmilk is so
much sweeter). If you want to give the baby some other sort of milk,
homogenized milk is acceptable at 6 months of age, as long as it is not
the baby’s only food. In fact, if the baby is taking good quantities of
a wide variety of foods, breastfeeding 3 or 4 times a day, and growing
well, homogenized milk or 2% milk is good enough, but also not necessary.
The “need” for formula to 9 months to 12 months of age is basically
formula company marketing and very successful at that. Statements by
the Canadian Paediatric Society and the American Academy of Pediatrics
urging formula to a year surely did not take into consideration the
baby who is continuing to breastfeed after 6 months.
Babies need to drink milk to get calcium. Not true. If you are worried about the baby’s intake of calcium, he can eat cheese or yogurt. There is no need to drink the calcium. Besides, if the baby is also breastfeeding, breastmilk still contains calcium.
Follow-up formulas (artificial milk for infants over 6 months of age)
are specially adapted to the needs of infants 6 to 12 months of age. Not true.
They are completely unnecessary and are specially adapted to the needs
of the formula companies’ profit margins. They also are part of a
marketing strategy that tries to get around restrictions on the
advertising of artificial baby milks directly to the public (widely
disregarded in any case). In Europe now, there are special formulas
available for the toddler (1-3 years of age). In Singapore, they have
formulas for children up to 7 years of age. Some people will buy
anything, it seems. But these toddler formulas will soon be here in
North America and soon nobody will consider it unusual to feed formula
to a 3 year old. In fact, just as some paediatricians in France now
push formula to 3 years, some paediatricians in North America will too.
You can bet on it. Bottom line über alles. We will all soon be on formula from birth to death.
The breastfed baby 4 months of age needs to be getting more iron than can be provided by breastmilk alone. Not true.
For the baby born at term who is breastfeeding exclusively, all the
iron required is provided by breastmilk. However, by 6 months of age,
more or less, it is prudent for the baby to begin getting more iron
than that provided by breastmilk alone. The best way for your baby to
get iron is through his food, and the best source of iron is meat, not
formula, and not infant cereals.
The best way to assure the baby’s getting enough iron is to give him infant cereals.
Not true. Infant cereals do contain a lot of iron, but most of
it is not absorbed, and this amount of iron seems to cause constipation
in some babies. Furthermore, some breastfed babies who have had only
breastmilk to 5 or 6 months of age do not like cereal. There is nothing
wrong with infant cereal, but pushing this food on reluctant babies may
result in later feeding problems. The best way to ensure the baby is
getting enough iron is to continue breastfeeding, and introduce solid
foods in a relaxed, enjoyable way at the appropriate time (See the
information sheet Starting Solid Foods). The appropriate time
is when the baby is showing interest in eating by reaching out for and
trying to eat food the parents or other members of the family are
eating. This occurs usually about 4 ½ to 5 ½ months of age. A baby this
age can eat what the parents eat, with few exceptions. There is no need
to be obsessive about the order in which foods are introduced, or
trying to keep the baby eating only one food/week. The easiest way to
give extra iron for the 6 to 12 month old baby is meat, the iron of
which is very well absorbed. Start feeding the baby solids in a way
that makes eating enjoyable and the baby will eat iron-containing foods
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
What to Feed the Baby when the Mother is Working Outside the Home, February 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©