Breastfeeding Nutrition: Country Specific Recommendations

Here are a few specific nutrient recommendations for breastfeeding women in the United States (US) and United Kingdom (UK). As you’ll see, some of these differ, so choose which recommendations you want to follow!

UNITED STATES

Fish Intake & Mercury—
Fish is a good source of vitamins, minerals and essential omega 3 fatty acids. The American Academy of Pediatrics (AAP) recommends an average daily intake of 200-300mg of omega 3 long-chain polyunsaturated fatty acids (docosahexaenoic acid [DHA]). This can be met through the consumption of 1-2 portions of fish a week. The general guideline is to aim for 8-12 ounces of cooked fish a week, choosing lower mercury containing fish (examples are herring, canned light tuna, salmon, flounder, tilapia, trout, pollock, catfish) while avoiding intake of predatory fish (e.g., shark, pike, marlin, King mackerel, swordfish, tile fish) due to their likely higher mercury levels. For the same reason, choose light canned tuna instead of canned “white” tuna (albacore). If you consume canned “white” tuna (albacore), have less than 6 ounces a week. If you don’t include fish in your diet, then some non-fish sources of omega 3 fatty acids are canola oil, soybean oil, ground flaxseed and walnuts.

Calcium—
In the United States, the calcium recommendations are the same for adult breastfeeding and pregnant women (19-50 years of age) at 1000mg/day. Look for calcium rich sources like dairy products, calcium and vitamin D fortified drinks, breakfast cereals and breads fortified with calcium.

Vitamin D—
For a breastfeeding mother, 600 international units (IU) or 15 ug of vitamin D is recommended daily. It is generally easier to meet these recommended vitamin D intakes in the United States because more commercial products tend to be fortified with vitamin D. Examples are many cow’s milk, yogurts, and cheese dairy products, calcium and vitamin D fortified soy milk and juices, and breakfast cereals like General Mills Total® cereal.

Vitamin & Mineral Supplementation—
According to the AAP, there are currently no routine recommendations for maternal supplements during breastfeeding, though many doctors recommend continued use of prenatal vitamins. Poorly nourished mothers or those on selective vegan diets may need multivitamin and omega 3 supplements.

UNITED KINGDOM

Fish Intake & Mercury—
Breastfeeding women are recommended to have no more than 2 portions of an oily fish a week (examples of oily fish are fresh tuna, salmon, mackerel, sardines, herring, pilchards and trout). If predatory fish like shark, swordfish, marlin are consumed, it is recommended that no more than 1 portion of these fish are consumed a week. There is no restriction on the amount of canned tuna a breastfeeding woman can have. In the UK, however, canned tuna does not count as oily fish as they are low in the good fats and in vitamin D due to the processing methods used.

Calcium—
Calcium recommendations actually jump from 700mg a day for an adult pregnant woman to 1250mg a day for a breastfeeding mother! One cup of milk has about 300mg of calcium, so this would mean aiming for at least 3-4 servings of calcium rich products a day. Examples are dairy products like cow’s milk, yogurt, cheeses, fromage frais; calcium and vitamin D enriched oat milk, rice milk and soy milk (note that ‘organic’ versions mean these are not fortified with calcium or vitamin D); calcium fortified breads and cereals.

Vitamin D—
The UK Department of Health recommends that all pregnant and breastfeeding women have 400 international units (IU) or 10 ug of vitamin D daily. Some food sources of vitamin D include oily fish, fortified margarine and eggs. Here are also some foods on the market that are fortified with both calcium and vitamin D: certain breakfast cereals like Kellogg’s Corn Flakes®, Weetabix Crunchy Bran®, Ready Brek® porridge, and calcium and vitamin D fortified cow’s milk alternatives like soy milk, rice milk and oat milk.

Though food in the diet can contribute to vitamin D levels, it may be difficult to obtain enough vitamin D from diet alone (especially in the UK where many foods on the market like dairy products are not fortified with vitamin D). Our bodies can also manufacture vitamin D through modest exposure to direct UVB sunlight. However, factors like variable weather conditions, use of sunscreens, different skin types and cultural practices may all impact on vitamin D levels. So for those who find it hard to get enough vitamin D from the sun and their diet, a vitamin D supplement might be needed.

Does My Baby Need Vitamins?

UNITED STATES

The FACTS:
Of all the vitamins, I think the most crucial for your infant is vitamin D because breast milk provides limited amounts of vitamin D, so if you are exclusively or partially breastfeeding then it is recommended by the American Academy of Pediatrics (AAP) in the United States to give your baby a daily dose of 400 International Units (IU) of a vitamin D supplement starting from soon after birth. If you are doing mixed feedings with formula, your baby will need at least 27 ounces (about 800 ml) of standard formula to get 400 IU of vitamin D. Hence, the AAP also recommends a daily 400 IU vitamin D supplement for all nonbreastfed and partially breastfed babies getting less than 1 liter of vitamin D fortified infant formula (1000ml) a day. The AAP further recommends that older children and adolescents who are not getting 400 IU vitamin D from at least 1 liter of vitamin D fortified milk a day or through other vitamin D rich sources, should also receive a 400 IU vitamin D supplement daily (one 8 ounce serving of a glass of milk provides roughly 100 IU vitamin D).

It is worth noting that in 2010, the Institutes of Medicine (IOM) in the United States recommended an increase in the RDA for vitamin D to 600 IU or 15 micrograms (mcg) per day for children over one year of age. It is likely that the current AAP recommendation of 400 IUs per day will be reconsidered.

 

The EXPERIENCE:

There are MANY infant vitamin supplements on the US market (compared to the 2 or 3 main brands/products I tend to recommend in the UK!). The local pharmacies and retail shops carry products like Enfamil Poly-Vi-Sol, Poly-Vi-Sol with iron, Tri-Vi-Sol (Vit A, D, C) or D-Vi-Sol (vit D). But online from websites like Amazon, there are a lot more products offered like Carlson Labs Vit D Baby Drops 400IU, Twinlab Infant Care Multivit Drops with DHA and D Drops Liquid Vit D3. Most of the vit D seems to be in D3 form.

I happened to be by a CVS, so I got the Enfamil Poly-Vi-Sol product to try. It tastes horrible! I found I had to wait till my baby was taking 3-4 tbsp of baby rice/oatmeal at a sitting, before I could begin adding a few vitamin drops into the food without it affecting the taste of the food much. Either that, or I needed to put the vitamin drops into mashed avocado, or into very sweet foods like yoghurt or sweet wheat cereal which helped to dilute the sweetness. I also ended up ordering an infant vitamin D supplement (Carlson’s brand Super Daily D3 for Baby) online as it was recommended to be tasteless and only one drop a day was needed (compared to 1ml a day for the Poly-Vi-Sol). I tried this out and it’s true—it’s absolutely tasteless and only one drop is needed! I wish I had known about this sooner. So if you are exclusively or mainly breastfeeding and need to give a vitamin D supplement right away, I would recommend going for a ‘tasteless ‘or ‘taste neutral’ product, which can also be put on the nipple before letting the baby latch on, or easily put onto the spoon when feeding the baby solids. Hope this helps!

UNITED KINGDOM

The FACTS:
The UK Department of Health recommends that all babies and young children from 6 months to 5 years of age receive vitamin supplement drops containing vitamins A, C and D. In particular it is important that these supplements contain vitamin D to meet this age group’s vitamin D requirements of 280 – 340 International Units (IU) or 7-8.5 micrograms a day. Babies who are fed infant formula (which are already fortified with vitamin D) would not need vitamin drops until they are having an intake of less than 500ml of formula a day. In addition, breastfed babies may need to start vitamin D supplement drops from one month of age if their mothers did have not take any vitamin D supplements during pregnancy.

The EXPERIENCE:
In the UK, there are fewer vitamin infant drops products available on the market. Some possible options are Dalivit and Abidec brands. If you qualify, your child may be able to receive free vitamin drops through the Healthy Start program available in some areas. In terms of giving your baby vitamin drops, if he or she refuses to take the drops off a spoon or syringe, then adding the vitamin drops to the baby’s food often works well.