Last month, Health Canada, in collaboration with the Infant Feeding Joint Working Group, published a position statement for healthcare providers with the latest recommendations for healthy infant feeding (babies birth to 6 months of age).  Below is a shorter parent-oriented summary of the recommendations.  It is by no means comprehensive, so feel free to review the entire document which can be found here.

1. Breastfeeding is the normal and unequaled method of feeding infants.

It is recommended that a mother exclusively breastfeed for the first six months of her baby’s life.  Mothers should feel encouraged to continue breastfeeding for up to two years or longer.

Mothers who are having difficulty breastfeeding should seek help from a physician with expertise in lactation medicine or from an international board-certified lactation consultant.

2. Breastfeeding rates increase with active protection, support, and promotion.

The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) was developed to improve breastfeeding outcomes for infants and their mothers worldwide.  Hospitals and community health services are encouraged to provide breastfeeding-friendly environments in order to support and protect breastfeeding for mothers and their infants.

To be considered ‘baby-friendly’, a health care center must follow the WHO/UNICEF’s Ten Steps to Successful Breastfeeding  and abide by their International Code of Marketing of Breast-milk Substitutes. Presently, 15 hospitals in Canada have been designated baby-friendly.

To ensure successful breastfeeding, mothers should make an effort to seek pre and post-natal care from institutions that are Baby-Friendly and or operate in the spirit of supporting and promoting the Baby-Friendly Hospital Initiative.

3. Breastfeeding is rarely contraindicated (advised against)

There are only a handful of situations where a mother cannot, or should not, breastfeed. These include:

a. Mother who is HIV+
b. Mother with active herpes lesions on both breasts
c. Mother with active untreated tuberculosis
d. Mother who is receiving chemotherapy or radioactive drugs
e. Infant who has the metabolic condition called Galactosemia

Most medications, when taken by a breastfeeding mother, can be found in her breast milk.  However, the vast majority of prescription drugs accumulate in breast milk to only a trivial extent.  With few exceptions, breastfeeding while taking appropriately prescribed medications is safe for the baby.  This may not be the case, however, for illicit/street/recreational drugs, so mothers using such drugs should be encouraged to stop, or to minimize use as much as possible. For further information about the safety of using medications while breastfeeding, refer to (or encourage your doctor/midwife to refer to) the Motherisk website (English) or the  centre IMAGe website (French).  These sites offer extensive information about the transfer of drugs and health products to breast milk and their potential effects on milk supply or on infant health.

4. Recommendations on the use of breastmilk substitutes

When it is not possible for a mother to exclusively breastfeed her infant, an infant should be fed an appropriate substitute. In this circumstance (and in order of preference), the following substitutes should be considered:

a. Expressed breastmilk from the infant’s own mother
b. Pasteurised human milk from appropriately screened donors
c. Commercial infant formula

5. Supplemental vitamin D is recommended for breastfed infants.

Not all mothers have sufficient vitamin D levels to generate enough vitamin D in their breast milk for their babies. It is not possible to identify which mothers have sufficient vitamin D levels and which mothers do not.  Therefore, it is recommended that all exclusively and partially breast-fed babies be given 400 international units of vitamin D per day.

6. First complementary foods should be iron-rich

Iron is critical for an infant’s brain development.  After six months of age, iron stores from birth are at risk of becoming depleted.  Furthermore, after 6 months of age, infants may not get sufficient iron from breastfeeding alone. Infants’ first complementary foods should therefore be iron-rich.  When ready to consume complementary foods, usually at around 6 months, infants should begin eating iron-rich foods such as fish, meat, eggs, tofu and legumes. Parents and caregivers should try to feed their infants these iron-rich foods two or more times daily.

Signs that your infant is ready for complementary foods include good head control, ability to sit up and lean forward, ability to let the caregiver know when they are full (e.g, turns head away), and ability to pick up food and try to put it in their mouth.

For tips and ideas around introducing complementary foods, consider reading this blog post on introducing solids to babies.

Summary

To best nourish an infant, breastfeed exclusively for the first 6 months.  Get pre and post-natal care from health care institutions that are baby-friendly or who abide by the Baby Friendly Hospital Initiative.  There are only very few conditions for which it is advisable to not breastfeed. In such circumstances, choose an appropriate substitute. Exclusively or partially breastfed infants should be given 400 I.U. of supplemental vitamin D daily. When the baby is ready (usually around 6 months of age), add complementary foods that are rich in iron. Continue breastfeeding for up to two years or more.

If you have any further questions or concerns, speak with a physician or allied health care professional with expertise in infant nutrition.

Special thanks to Emily Murray for her help writing this summary.