3.2. The Postpartum Period: Feeding Baby
Scientific organizations including the American Academy of Pediatrics (AAP) and the Academy of Nutrition and Dietetics (AND) recommend exclusive breastfeeding for six months, with continuation for one year or more, as desired by the mother [52,53]. A World Health Organization review along with an opinion paper published by the European Food Safety Authority (EFSA) described that exclusive breast feeding by well-nourished mothers for six months can meet the needs of most healthy infants for energy, protein, and for most vitamins and minerals, with the exception of vitamin K and vitamin D, both of which can be addressed by supplementation [54,55].
Lactating women require nutrients in increased amounts in comparison to non-pregnant women, including vitamins A, E, B6, B12, choline, folate, iodine, lutein and zeaxanthin, zinc, omega-3 fatty acids, as well as increased amounts of fiber and protein (Table 2). Nutrients that are low in breast milk include zinc, iron, and vitamin D. Several scientific organizations recommend supplemental vitamin D to infants, and especially to exclusively breastfed infants. Infants receive most of the required amount of vitamin D from sun exposure, and the rest from formula or breast milk [53,56]. For breastfeeding mothers, only minimal amounts of maternal serum 25(OH)D are transferred to human breast milk; therefore, to provide sufficient vitamin D content in breast milk for the infant, the vitamin D intake of the mother during lactation has to be much higher compared to the intake during pregnancy. Overall, mothers who choose to breastfeed can consider micronutrient supplementation [1].
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While breastfeeding is considered the gold standard for feeding infants, it is not always possible for all mothers to achieve. Potential barriers to breastfeeding include overall discomfort, improper latching, lack of knowledge or uncertainty about breastfeeding, and the stress of returning to work [57]. Breast milk and formula provide infants with water, carbohydrates, human milk oligosaccharides, essential fatty acids, proteins, carotenoids, and vitamins and minerals [58]. Human milk contains nutrients, growth factors and cells important for brain development that formula lacks, however, formula contains vitamin D, iron, and omega-3s that may be insufficient in breast milk, especially if the mother is deficient [1]. It is important for families to consult with health professionals to develop a feeding plan that gives the mother and baby the best chance for health and healthy development.
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