Baby Care

Nutrition for nursing mums

As an adult there is unlikely to be any other time in your life where you require so many extra nutrients. It only takes a few glances at your baby, who can appear to grow overnight, to realise that if you are their single source of nutrition you are going to have to put some extra nutrition into your diet. Skipping meals, taking short cuts or over-doing things, can quickly take a toll, and remember a happy, healthy mum makes parenting a whole lot easier.

Having said that, nursing mothers are not exempt from imperfect eating habits and if you look at the overwhelming numbers of infants being raised in sub-optimal living conditions around the world it becomes clear that only severe and prolonged restriction significantly alters breastmilk. Mother nature has made food for babies very resilient so that our future has the best chance.

How much more is enough?

All in all, we are not absolutely sure of how many kilojoules any one nursing mum requires. Research tends to suggest that women who maintain a stable weight while breastfeeding take in about an extra 2500 kJs/d (around 590 calories). Current government recommendations are an extra 2000 – 2100 kJ/d. Factors such as dietary habits, weight gain during pregnancy, method of feeding (exclusive or complementary), ethnicity, health status and activity levels all need to be accounted for. I know that doesn’t make it sound easy. The best guide is you and your body. Avoid being hungry, monitor your energy levels and eat a healthy varied diet, and make adjustments as needed. Stick to whole, natural and unprocessed foods where possible and keep in mind that eating a wide variety of food appears to expose baby to a wide array of tastes that may assist with eating habits later. Breastfeeding generally creates an appetite: if you find that you are uninterested in food or if you are in any doubt chat to your early childhood nurse or see an appropriate health care professional.

It’s probably worth noting that in order to produce milk you don’t require any special food yourself – such as milk for example. The amount of breastmilk you make is by and large a function of demand, that is, if baby requires more milk, your body responds by making more available. So if baby is going through a growth spurt, offering an additional feed will mean that your body will, over the course of a few days, produce more milk.

Based on an average milk production of about 850ml a day, breastfeeding may mean you need an extra 2000-3000 kJ per day (around 600 calories a day). There is, of course, a huge variation from one mum to the next, but this gives you a bit of a rough guide.

You may have noticed a few extra lumpy bits around your thighs, and yes, sorry girls, butt. The good news is that part of the energy needs for breastfeeding can be met by these clever little stockpiles (usually around 2-4 kg) that have been deposited prior to baby arriving. That’s just one of the many benefits of breastfeeding.

Almost all nutrients are required in greater amounts in order to supply breastmilk with its power-packed nutrition, and in many cases additional calories are also required. If you are already eating a very healthy nutrient-packed diet then you may simply need to eat a little more, whereas others may need to make dietary changes to ensure they gain the increased nutrients.

It’s believed that only severe and prolonged restrictions to intake significantly affect breastmilk. Rather, deficits tend to affect mum, so perhaps you could say the effect on baby is indirect. Most mums will agree when they feel rested (don’t scoff, it can happen, sometimes), healthy and well-nourished that parenting can be a whole lot easier.

What does that equate to?

590 calories is about the size of a low-fat meal; the ideas below are just 250 calories, so you can see 500+ is a reasonable-sized meal.

  • Pita bread and hummus snack
  • Banana smoothie
  • Toasted sandwich
  • Bowl of cereal and some yoghurt
  • Egg and toast

Many mums find eating small additional snacks the easiest option. It can be less taxing and time consuming to grab a snack than to prepare a meal. Some snacks include:

  • Smoothies
  • Nuts and dried fruit
  • Cream cheese bagel
  • Toasted cheese sandwich
  • Baked beans on toast
  • An egg on toast
  • Baked beans on toast
  • Salmon and cream cheese bagel
  • Fruit and yoghurt

So next time you pop onto the sofa and ‘assume the position’, grab a healthy snack to nourish you both. Do this at least twice in the day and you will be doing nicely.

For a more comprehensive guide, we can use the food groups and servings guides below (see also www.healthed.govt.nz for Healthy Eating booklets).

Figure 1 Amounts of foods required to meet at least 70% of the RDIs for nutrients for lactating women. Amounts based on an energy range of 9200-12300 kJ/d.
Food group Serving examples Serves/d Compared to pregnancy
Breads/cereals 2 slices of bread
1 cup cooked rice, pasta, noodles
1 1/3 cup of breakfast cereal
1 cup of porridge
5 – 7 4-6
Fruit 1 medium piece of fruit (150g)
2 small fruit
About 8 strawberries
About 20 grapes or cherries
5 4
Vegies 1 cup of cooked vegies (75g)
1 cup of salad
1 small potato
7 5-6
Dairy 250ml milk
200g pot of yoghurt
40g or 2 slices of cheese
2 2
Meat/equivalents 65-100g cooked meat
80-120g cooked fish
2 small eggs
65-100g cooked legumes
2 1.5
Extras 1 doughnut
3 sweet biscuits
25g of chocolate
0-2.5 0-2.5

Source: Food for Health, dietary guidelines for Australians; A guide to healthy eating, Australian Government, Dept of Health and Aging, NHMRC 2005

The nitty gritty details

Don’t be too focused on numbers, that’s truly what eating is not about. Focus instead on quality, nutrient-dense meals at regular intervals. An increase in total food intake, if from healthy options, will generally go hand-in-hand with an increase in most nutrients. Nursing mums don’t need extra stress from number-crunching RDIs and so on.

For those who like to know, the following details reflect the nutrients that are required in greater quantities; the figures in the brackets are the RDIs during lactation.

  • Protein (67 mg/d)
    Increased protein requirements to account for the production of immune substances and amino acids for development of tissue. Up to 70% of protein is utilised in milk production. Protein requirements increase to 1.1 g per kg of body weight.
  • Vitamin A (1100µg/d)
    Also required for tissue production. The RDI is based on the transfer of about 425 µg per day to baby, hence the increased requirement is +400µg per day.
  • Vitamin C (80mg/d for 14-18 year olds and 85mg/d for other)
    Breastmilk contains a concentration of vitamin C and on average there is 50 mg/d secreted into breastmilk. Interestingly though, the levels in breastmilk are reasonably stable.
  • Vitamin D
    Also emerging as a health concern, particularly in populations who have dark skin and those who are veiled or housebound. While the upper limit (UL) is unchanged from 80µg/d across the lifespan, it is important to ensure that these at-risk groups are monitored. The adequate intake (AI) is given to be 5µg/d across all age groups.
  • Thiamine (1.4 mg/d)
    The B-group vitamins are integral in the energy production that is required in order to produce milk. The increase of 0.3 mg/d is based on the amount that appears in breastmilk and the increase in energy demand from breastfeeding.
  • Riboflavin (1.6 mg/d)
    Also increased and based on energy demands; is currently at 0.5mg extra per day.
  • Niacin (17 mg/d)
    Niacin, too, is required for lactation (about 1 mg/d), and along with the amount in breastmilk (around 1.4mg) it is estimated that an additional requirement of 2.4 mg /d is expected.
  • Vitamin B6 (2.0 mg/d)
    Required at +0.6mg/d due to the role of B6 in protein production and the level found in breastmilk.
  • Vitamin B12 (2.8µg/d)
    Required at +0.4µg/d based on about 0.33µg in breastmilk. Important to note, that vegan mothers should be monitored to ensure access to B12.
  • Folate (500µg/d)
    A deficiency of folate shortly after giving birth is quite common; an increased requirement is suggested to be 100 µg/d. Foods rich in folate include green leafy vegetables, legumes, nuts, beans and other vegetables. When folate is added to food it’s known as folic acid, and many labeled products are now fortified with B9. Many of our breakfast cereals, breads and juices are fortified with folic acid.
  • Iodine(270µg /d)
    Iodine has recently been emerging as a deficiency concern in Australia and New Zealand and is essential for normal growth and development. The RDI rises considerably by 120µg /d. Foods rich in iodine include oysters, sushi (containing seaweed), canned salmon, bread with iodised salt, snapper, some cheddar cheeses and eggs.
  • Iron (10mg/d for 14-18 year olds and 9mg thereafter)
    One of the few nutrients required in lesser amounts, at least until a menstrual cycle is reestablished. The RDI drops to 9mg/d for the first 6 months. The iron intake in the maternal diet is not reflected in breastmilk, even under supplementation. Women who experienced issues related to iron status during pregnancy should also consult a healthcare professional about ongoing monitoring.
  • Zinc (11mg/d for 14-18 and 12mg there after)
    Zinc is found in breastmilk at levels of around 1.35mg/litre, and based on this and the uptake (availability of 42%) of zinc the RDI is increased by 4mg/d.

Key RDI = Recommended dietary intake µg = micrograms mg = milligrams

What about extra calcium?

Calcium levels are fairly stable due to a number of physiological changes in your body, so the amount required is unchanged. During lactation your body is better able to absorb calcium from food in the intestines, plus there is an increased bone turnover (which is replenished during weaning) and possibly an increased retention of calcium. Altogether this aids calcium balance. The RDI for calcium is 1300mg/d for 14-18 and 1000mg thereafter.

Superfoods may help

Research consistently shows that to prevent disease, to live longer or just be healthier, we need to eat fruit and vegetables, whole grains and healthy fish; do regular exercise; and avoid smoking and alcohol. There is some argument for supplements such as fish oils and certain other nutrients that are low in our diets, so it is best to get advice on these.

As well as eating a wholefood diet of mostly unprocessed foods we should consider certain foods that rate particularly highly for their health-giving benefits; we might call them ‘superfoods’. If you were to ask 10 nutritionists what they consider to be the top 10 superfoods you are very likely to get 10 very different answers. However, we know for sure that some foods pack more of a punch than others in terms of nutrient profile and beneficial compounds including antioxidants. When you pool the findings there are some very definite superfood contenders.

  • Fish, especially those high in omega-3 oils such as salmon.
  • Many vegies, particularly those that are strongly coloured such as dark green or orange vegetables such as broccoli and carrots, and those that are aromatic such as garlic.
  • Fruit, particularly berries and tomatoes, and those rich in vitamin C such as acerola and red peppers.
  • Nuts, seeds and foods rich in oils such as almonds, flaxseeds and avocado.
  • Herbs are finally beginning to be credited as superfoods, something many cultures have known for a very long time.
  • Yoghurt for healthy bacteria.

Smoothies are power-packed

One way to pack a bunch of superfoods into one meal is via a smoothie. Smoothies are one of the best snack foods. The combination of natural yoghurt, your choice of milk, ground nuts and seeds and some berries will help you maintain your fluid intake and adding in the extra calories will very likely meet many of your other nutrient requirements.

Fluid

Interestingly, the actual volume of breastmilk is reasonably stable regardless of your diet; however, ensuring you have plenty to drink will help in two ways. Firstly, oxytocin (the hormone involved in milk production) can cause feelings of thirst. Secondly, keeping your body well hydrated can reduce the risk of constipation and of course hemorrhoids – now that’s a definite motivator. Your urine should not be dark in colour or strong in odour, these can be signals that you are dehydrated.

Drink just to your desired level and keep an eye on the signs of dehydration so you can respond accordingly. Opt for water or healthy choices that are free from added sugar, additives and other unwanted compounds.

Weight loss

In many cases mothers will lose weight even with the extra caloric intake, though some may not begin losing weight until weaning starts or even later. Any effort to lose weight is best considered after baby is two months old, to allow both mother and baby to have settled into a routine and for their bodies to have adjusted to changes. Up to 2 kg per month loss in mothers who gained normal weight during pregnancy appears to be safe, with no adverse outcomes for baby or mother.

This information has been provided by Leanne Cooper from Sneakys baby and child nutrition. Leanne is a qualified nutritionist and mother of two very active boys.