Nutrition and Breastfeeding Articles

By Emma McShane & Nicole Bando, March 2022
 
Some people need to remove dairy and soy products from their diet due to a food allergy or intolerance. As these foods contain vital nutrients, including protein and calcium; important for the health of our bones and muscles, dairy and soy should be replaced with nutritious substitutes. This easy to follow guide provides simple swaps to help you enjoy the foods you love and get the nutrients you need.
 
*Please note that this resource is a guide only. Always check the ingredient labels of foods, medications and supplements for allergens, as ingredients may change.  This resource displays food products labelled as dairy-free (DF*) or soy-free (SF*) or both. Products ‘may contain traces’ of either soy or dairy, please consult with your allergist or dietitian for guidance. Please note that plant based milks may not meet the growth needs of young children, seek advice from a dietitian. Daily calcium requirements vary according to age and gender.

Are you breastfeeding and avoiding soy/dairy? See this article for more about how to meet your dietary needs.
See here for more about breastfeeding & nutrition.

For further label reading advice, see: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf
This does not substitute individual dietary and medical advice. 

By Emma McShane & Nicole Bando
​
New mothers need quick, convenient, and nutritious snacks and meals (see ideas & sample meal plan, below).
Choose carbohydrate foods that provide a slow, sustained release of energy, such as wholegrains e.g. wholemeal bread with seeds, oats, fruit, dairy, and starchy vegetables, such as sweet potato. These foods manage appetite and help to avoid sugar crashes. Avoid large quantities of high sugar, high-fat foods; these provide a quick release of energy, followed by a crash in blood sugar and energy levels, which can increase feelings of hunger and impact mood levels. Of course, the occasional chocolate or treat is OK.
 
Include a couple of pieces of fruit, and vegetables at least twice per day, dairy/dairy alternatives three times each day, lean meats (or alternatives), and healthy fats e.g. omega 3 & 6 fatty acids (from fish, nuts, etc.) three times each day.
For more information about the nutritional needs of breastfeeding mums, see these articles: Breastfeeding & Nutrition: www.nicolebando.com/blog/nutrition-during-breastfeedi and Weight loss after baby and special diets/situations: www.nicolebando.com/blog/weight-loss-after-baby-and-special-dietssituations
 
EASY IDEAS:
Meals:

• Omelettes loaded with frozen vegetables and cheese.
• Stir-fries with frozen vegetables and rice noodles.
• Pita bread with vegetables and low fat cheese as a cheats pizza
• BBQ chicken in wraps with salad mix.
• Meals that can be eaten hot or hold such as frittata, zucchini slice
• Serve grain foods like rice, pasta, quinoa or couscous with main-meals such as stir-fries, curries and casseroles.
• Buy meat and vegetables already diced

 
Snacks:
●      Boiled eggs
●      Individual serves of yoghurt
●      Cut-up vegetable sticks and fruit
●      Nuts & seeds
●      Canned fish, canned beans and lentils

• Leftovers – on their own or in a toasted sandwich
• Cheese and crackers

Download my easy list, below:
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By Emma McShane & Nicole Bando
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WEIGHT LOSS AFTER PREGNANCY
There is a lot of pressure from society on women to ‘bounce back' to their pre-pregnancy weight, however, this is not realistic nor recommended. Some of the weight gained during pregnancy is used to fuel breastfeeding, which is why breastfeeding can help a woman gradually return to her pre-pregnancy weight. Weight loss is recommended at the rate of around 2kg loss per month, as this does not affect breast milk production. It takes 9 months to grow a baby, so it is expected to take 9-12 months to return to pre-pregnancy weight. It helps to be patient, realistic and kind to the incredible body capable of growing a child. Restricting eating can affect not only a mother’s health but can reduce milk supply and impact a woman’s bone health. 
 
Aim to be intuitive with eating (e.g. listen to hunger cues), choose whole foods from the core food groups and avoid too many high sugar and high fat treat foods to help weight loss to occur gradually. See these posts on a woman's special needs whilst breastfeeding: www.nicolebando.com/blog/nutrition-during-breastfeedi and www.nicolebando.com/blog/meal-snack-ideas-for-new-parents
 
Gentle exercise has been shown in multiple studies to effectively help with post pregnancy weight loss. Exercise can help to boost overall health and wellbeing too. It is important to let the body recover after birth, and when ready, commence gentle exercise to strengthen your bones and muscles, improve sleep and stress levels, help to lose weight, and improve mental wellbeing.
 
SPECIAL DIETS/SITUATIONS:
 
VEGAN & VEGETARIAN DIETS:
Mothers who are vegan or vegetarian are at high risk of nutrient deficiencies, in particular; protein, iron, calcium, Vitamin B12, and omega-3 fatty acids. These nutrients can mostly be obtained from plant-based products, except for Vitamin B12, which is mainly found in animal products. In some cases, a blood test to check levels, and a B12 supplement may be required.
 
INTOLERANCES/ALLERGIES:
Some babies may have intolerances or allergies to proteins present in their mother’s breast milk. The most common allergies are cow’s milk, soy, eggs, peanuts, and tree nuts. Avoidance of the particular protein in the mother’s diet may be needed. However, each mother and baby duo is different, so seek medical advice from a doctor and dietitian before excluding food group(s). If a mother needs to exclude a particular protein, the nutrients from that food will need to be replaced with alternative foods (e.g. alternatives to cow’s milk for adequate calcium).
 
 
CLOSE PREGNANCIES & MULTIPLE BABIES:
Mothers who have close pregnancies are at higher risk of nutrient deficiencies, as the nutrient reserves in the body may not have been fully replenished before the next pregnancy. Iron is at most risk of deficiency, as the body may not have had time to fully replenish the stores lost during pregnancy. Supplementation of this nutrient, as well as calcium, magnesium, zinc, and essential fatty acids may be needed but it is important to seek support and guidance from a dietitian who can accurately assess your dietary intake and blood levels of these nutrients. Women who have had multiples (e.g. twins) have greater demands for nutrition and need an additional 2000kJ in energy, per baby, as well as increased vitamin and mineral needs.
 
BARIATRIC (WEIGHT LOSS) SURGERY:
There have been multiple studies that have investigated the impact of bariatric surgery on breastfeeding. People who have had bariatric surgery may be at greater risk of nutrient deficiencies, as the surgery can change how nutrients are absorbed, so it is important to check levels of vitamins and minerals before, or at the start of pregnancy, to see if supplementation is needed.  A study investigating the composition of breastmilk, comparing nourished mothers who had undergone weight-loss surgery and those that had not, found there was no significant difference in nutrient composition between the two. This, however, takes into account that it is important to still consume a balanced diet. As some bariatric surgeries may result in ongoing complications e.g. reflux or reduced food consumption or absorption, which all may affect nutrient intake, it is important to seek support from a dietitian.
 
PREMATURE OR LOW BIRTH WEIGHT BABIES:
Breastfeeding is important in babies who are premature or of low body weight as breastfeeding can reduce the risk of the baby developing medical complications. The production of milk components starts in pregnant women before 22 weeks of pregnancy, so even with very premature babies, most mothers can produce colostrum. Breastfeeding may be difficult if a baby is in the neonatal intensive care unit, requiring some mothers to express breastmilk. There are multiple barriers for both mother and baby to overcome when breastfeeding a premature, or low birth weight baby, such as a delayed or traumatic start to breastfeeding, and maternal stress. Recent studies however have shown that there is a higher rate of breastmilk feeding amongst very low birth weight infants, often due to mothers recognising the fragile health of their baby and the benefits of breastfeeding.
 
Good nutrition at this time is vital to cope with the energy demands of expressing and or breastfeeding, to maintain supply and provide energy to cope during a stressful time, and to replete nutrient stores used during pregnancy. Follow the general nutrition advice set out above. If you have experienced a bumpy start to breastfeeding, seek guidance from a lactation consultant.
 
NAUSEA & VOMITING IN PREGNANCY:
Some women experience severe nausea/vomiting during pregnancy that can affect the quality and quantity of food consumed. It is important during this time to eat high-energy and protein foods such as eggs, dairy, and meats/meat alternatives. Try having cold foods, as hot foods and their smells can exacerbate nausea. If nausea/vomiting continues, seek advice from a doctor and dietitian to see if supplementation of specific nutrients is needed. A woman who has experienced severe nausea and vomiting in pregnancy may be at greater risk of vitamin and mineral deficiencies and will need extra help to replenish her stores. 

By Emma McShane & Nicole Bando 

Nutrition whilst breastfeeding is vital to optimise the health of both mother and baby. New motherhood is a very busy time, and many women put their own health last.  A woman’s remarkable body will produce the live, biodynamic, complete food that is breastmilk that evolves with her baby’s growing needs. Milk production is robust and will only be affected in very extreme circumstances. The average woman produces 750mls of breastmilk per day, from 1-6 months. Fat stores accumulated during pregnancy are used to fuel milk production when baby arrives, though this does not cover all of the energy needed to produce breastmilk. Some elements of breastmilk are impacted by a woman’s diet and those that follow a vegetarian or vegan diet, are at greater risk of vitamin and mineral deficiencies.
 
DID YOU KNOW?

• Adequate nutrition can help with coping with a new baby and the adjustment to motherhood, mood, and energy levels. Restrictive eating during breastfeeding can impact mood, milk supply, overall coping, and bone health.

• Certain nutrients in breastmilk, such as lactose and protein are fairly constant, however the fat content of breastmilk changes according to how empty the breast is. The types of fatty acids and quantities of iodine and Vitamin B12 are also affected by the mother’s diet.

• A mother’s varied diet exposes baby to different flavours and tastes, which will help baby to accept a wider range of solid foods, including fruit and vegetables.

• Regular nutritious meals and snacks are important to nourish both mother, and baby. There is no need to aim for dietary perfection.

 
ENERGY:
An extra 2000kJ per day is needed for a breastfeeding mother, though this can change depending on individual needs. This is equivalent to a serving of spaghetti Bolognese with cheese (1 cup pasta and ½ cup sauce), or a bowl of porridge with apple, yoghurt, and nuts (½ cup uncooked oats, made with 1 cup of milk, 1 apple and a handful of nuts) or a combination of snacks throughout the day, such as yoghurt (¾ cup), popcorn (small packet/1 cup), crumpets, and peanut butter (1 crumpet with 1 tb of nut butter). Studies show that not eating enough can directly impact milk supply and composition, so a wholesome diet is vital to fuel both mother and baby.
 
FLUID:
Breastmilk production requires fluid, so a breastfeeding woman requires more fluid than usual. The amount depends on various factors such as weather conditions, activity levels, and the food eaten. Be guided by your body, and ensure you’re drinking water consistently throughout the day.
 
CAFFEINE:
Caffeine transfers directly into breastmilk, so avoid large quantities of caffeinated drinks when breastfeeding. 1% of caffeine enters breastmilk and peaks an hour after consumption. A newborn baby can take up to 160 hours to process caffeine, however by 6 months that drops to 2-3 hours, so an older baby is able to better tolerate caffeine. A morning latte or a few cups of tea across the day might not cause any issue, but observe baby; a mother may consider changing to a decaffeinated tea or coffee if she notices that her baby is very wakeful after her morning coffee. A moderate amount of caffeine a day, such as two cups of coffee (latte or espresso), three cups of instant coffee or four cups of tea is usually fine. Remember that sources of caffeine include: cola, chocolate, tea, guarana, and energy drinks.
 
Caffeine can also affect the let-down (the milk ejection reflex) and worsen nipple vasospasm (occurs when blood vessels tighten and spasm, causing nipple pain).
 
ALCOHOL
The safest option while pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

MIXED FEEDING:
Any amount of breastfeeding increases a woman’s dietary requirements, however given the wide variation in breast milk production when mixed feeding, it can be difficult to estimate. A woman should use her appetite as a guide and may require additional foods from the core groups. A dietitian can help to guide this.

DO CERTAIN FOODS INCREASE BREASTMILK PRODUCTION?
Oats: Many women wonder if oats or lactation cookies help with milk supply, however, there is no clear evidence to support this.
Fenugreek: There is poor quality and limited evidence to suggest that fenugreek increases milk supply.
Breastfeeding with good attachment, flexibly and frequently is the best way to protect milk supply.

IMPORTANT NUTRIENTS:

Breastfeeding is a normal, learnt skill that takes time and practice.
Breastmilk provides all the nutrition your baby needs for the first 6 months of their life.
From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to 2 years and beyond (WHO, UNICEF)
 
What are the health benefits of breastfeeding for your baby?

• Breastmilk is the perfect food for your baby. Breastmilk is a live, biodynamic fluid that changes in accordance to your baby’s age and needs.
• Breastmilk contains all the nutrients and hydration that your baby needs in the first 6 months of their life, and includes essential factors such as antibodies, antibacterial agents, probiotics, growth factors and long-chain fatty acids to optimize the growth of your baby.
• Due to these vital nutrients that help to support your baby’s health and immune system, breastfed babies are less likely to experience illness in the first 6 months of life.

What are normal feeding patterns for a newborn?      

• Frequent breastfeeding encourages good milk supply and growth in your baby.
• Babies vary in their feeding needs. Some babies may need as much as 10-15 times a day, or as few as 6-8 times in 24 hours.
• Nurse at the first signs of hunger (stirring, hand in mouth, fidgeting, squirming, fussing).  
• Newborn babies should be fed every 1-3 hours.
• It is normal for your baby to lose a little weight (10% of their body weight) in the first week of life. After this, your baby should be steadily putting on weight and growing each week.

HOW DO YOU KNOW IF YOUR BABY IS GETTING ENOUGH MILK?

URINE OUTPUT (WEE)
Minimum of 5 heavy, wet nappies each day (24 hour period) after the age of five days.
Pale urine – if your baby’s urine is dark or smelly, it might mean your baby is not getting enough milk.

STOOL OUTPUT (POO)
Good-sized soft stools are expected.
Before 6-8 weeks of age, your baby should have three or more runny stools/poos a day.
After this age, it is quite normal for your baby to poo less often, even every 7-10 days.
When your baby poos, there should be a large amount of soft or runny poo.

GROWTH
Your baby is gaining a good amount of weight, and growing in length and head circumference. Your baby is meeting their developmental milestones.

APPEARANCE 
Your baby is fitting into their skin, and has good skin colour and muscle tone.
Your baby is alert and is mostly happy after feeds.

• You cannot overfeed a breastfed baby, but you can underfeed your baby.

What do you do if you think your baby isn’t getting enough milk?

• The best way to increase your baby’s intake and your milk supply is to feed more often.
• It is important to let your baby finish the feed on their own and come off the breast by themselves, this will mean that baby is taking the most milk out of the breast as they would like.
• Have you only been offering one breast every feed? Some babies only need one breast, but other babies need both. You could try offering the second breast and see if your baby takes it.
• Is your baby sleeping longer at night? Long nights sleep can mean missed feeds, which can reduce milk supply, baby’s milk intake and weight gain. You might consider waking your baby up for a feed during the night.
• Is your baby attaching and sucking effectively? Babies with poor sucking action may not be capturing enough milk from the breast. An appointment with a Lactation Consultant can help you learn how to position your baby.

Breastfeeding should be an enjoyable and rewarding bonding process for both Mother and Baby.
Breastfeeding effectively does take time and practice as it is a learning process for both Mother and baby.
References:

1. Stuebe A. (2009) The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol.;2(4):222-231. Accessed June 7th 2021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_DiscoveryDbLinks&ordinalpos=1&tool=pubmed

 

1. Bonyata K. (2018). Is your baby getting enough milk? Kelly Mom. Accessed June 10th 2021. Available from: https://kellymom.com/bf/got-milk/supply-worries/enough-milk/

 

1. Bonyata K. (2018). Breastfeeding your newborn – what to expect in the early weeks. Kelly Mom. Accessed June 10th 2021. Available from: https://kellymom.com/hot-topics/newborn-nursing/

 

1. Australian Breastfeeding Association. General Breastfeeding Information.  ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).

 

1. Raising Children (2021). Breastmilk and breastfeeding: benefits. The Australian Parenting Website. Accessed June 10th 2021. Available from: https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/about-breastfeeding/breastmilk-breastfeeding-benefits

 

1. Eat for Health (2012). Infant feeding guidelines. NHMRC. Accessed 19th June 2021. Available from:https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56b_infant_feeding_summary_130808.pdf

Emma McShane, Dietitian

References:    

1. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Breakfast Cereals. Australian Government: Department of Health, 2013. (Available from: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~breakfast-cereals, accessed September 3, 2021).
2. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Savoury Snack Foods. Australian Government: Department of Health, 2013. (Available from:https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~savoury-snack-foods, accessed September 3, 2021).
3. Queensland Health. Sodium. The State of Queensland (Department of Health), 2021. (Available from:  https://www.healthier.qld.gov.au/guide/sodium/, accessed September 3, 2021).
4. Coles. Food products. Coles Supermarket, 2021. (Available from: https://www.coles.com.au/, accessed August 22 - September 3, 2021).
5. Woolworths. Food products. Woolworths Supermarket, 2021. (Available from: https://www.woolworths.com.au/, accessed August 22- September 3, 2021).
6. Tong, T., Rangan, A., & Gemming, L.  Evaluating the Nutritional Content of Children's Breakfast Cereals in Australia. 2018. Children (Basel, Switzerland), 5(7), 84. https://doi.org/10.3390/children5070084

By Emma McShane, Dietitian, August 2021

What is Mastitis?
Mastitis is inflammation of the breast tissue, affecting 10-25% of breastfeeding women. The majority of cases occur during the first 6 weeks of breastfeeding, however mastitis can occur at any time during the breastfeeding journey. Mastitis can be caused by engorgement or inadequate milk removal from the breast, resulting in a blocked duct. This causes the milk blocked behind the duct to be forced into the nearby breast tissue, causing inflammation. This inflammation is known as mastitis and can lead to infection. Fast and supportive treatment is needed, as mastitis can lead to early weaning from the breast, or complications such as a breast abscess if left untreated.
 
Mastitis may occur due to latching problems, sucking issues, sleepy babies, oversupply, or hurried feeds, including limiting a baby’s time at the breast. These factors can affect how much milk is drained from the breast.
 
How do I prevent Mastitis?

• Ensure your baby is well-positioned and attached to the breast.
• Make sure your bra is loose and there is no pressure on your breasts e.g. clothing or fingers while feeding.
• Feed on demand, offering flexible and frequent access to the breast, as missed feeds or long intervals between breastfeeding can increase your risk of developing mastitis.
• Relax whilst breastfeeding to help encourage your milk flow.
• Gently massage the breast by stroking towards the nipple whilst your baby feeds.
• If your breasts become uncomfortably full, wake up your baby to feed them. If they do not want to feed, express a small amount for comfort.
• Hand express to empty the breast.
• Practice good hygiene, and if using a breast pump, clean this often, as this will help to prevent contamination.
• Check your breasts frequently for lumps, pain, or redness.
• Alternate from which breast you begin each feed, as this will help to ensure one breast is drained well at every second feed.
• Let your baby finish when they’re ready to ensure they have taken the most milk out of the breast. Avoid timing your baby at the breast.
• If you choose to wean your baby, make sure you do this slowly as rapid weaning can cause mastitis.
• Stress, fatigue, vigorous exercise, or overall poor health and nutrition can increase your risk of mastitis, so self-care and adequate nutrition is essential.

 
Symptoms:
Please note that some mothers do not get the early signs of a blocked duct, and feel that mastitis comes on ‘out of the blue’. 

Treatment:
It is important that if you feel a blocked duct coming on, to start treatment immediately. The most important part of treatment is to allow for effective milk removal, regularly. 

• It is important to drain the breast often, but gently.
  
• Feed frequently, starting on the affected breast.  This is not the time to wean your baby as symptoms can worsen. Allow your baby to drain the breast and also make sure that you are offering the unaffected breast. The milk is safe for your baby to drink.
• Change feeding positions as this may help to clear the blockage. You can try positioning your baby at the breast with their chin or nose pointing to the blockage, as this will help drain the affected area.
• Gently massage your affected breast, as this will help to improve drainage and symptoms.
• Ensure good positioning and latch. A lactation consultant can help you to achieve this.
• Use cold packs on the affected breast, as this can help to reduce swelling and relieve pain. 
• Use warm heat packs sparingly just before bed (only for a few minutes), to help trigger your let-down to help clear the blockage.
• It is very important to get as much rest as possible.
• Simple analgesia can be taken as needed such as paracetamol or ibuprofen.
• When treated promptly, a blocked duct should clear in 24-48 hours. 
• If the blockage is not clearing within 24 hours, seek advice from your doctor, as antibiotics may be needed if an infection occurs. Please note that antibiotics only treat an infection, not the cause of the blockage. 
• Milk supply can sometimes be affected when mastitis is occurring, so look out for signs that your baby is getting enough milk including urine and stool output, and that your baby is putting on weight.  A change in supply can be addressed with frequent and effective feeding.
• A Lactation Consultant can check your baby's positioning at the breast to prevent mastitis & blocked ducts.
  
• Breast ultrasound can be an adjunct to treatment to help clear the blocked duct.  

 
Nutrition:
 It is very important to keep up your fluids, which means consuming >2 litres per day

• Breastfeeding is a demanding process on the body that requires more energy and protein than usual. Other important nutrients include iron, iodine, and calcium. A dietitian can help you to meet your requirements.
• Try to eat regular meals & snacks across the day, even if feeling unwell.
• Simple meal and snack ideas include: Scrambled eggs with toast and chopped vegetables, baked beans on toast, roasted chickpeas, vegetable sticks and hummus or cheese and crackers.
• Below is the Australian Guide to Healthy Eating recommended serves for each food group during breastfeeding.

 
Are probiotics helpful?

• Scientific trials have found inconclusive results on the benefits of probiotics to prevent or treat mastitis. There is an emerging field of research to suggest that probiotic use may help to prevent mastitis, however further research needs to be conducted in this area to reach a conclusion.

When a mother is breastfeeding a baby with an allergy or intolerance to dairy and/or soy proteins, these foods may need to be eliminated from the mother’s diet for 2-4 weeks, before possible reintroduction (under guidance of a health professional). These conditions include Cow’s Milk Allergy, Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein-Induced Enteropathy (FPIES).
 

• Both dairy and soy are common food sources of calcium, and many other important nutrients including Vitamin A, Vitamin B12, protein, zinc & magnesium.
• Calcium is vital to ensure strong bones and teeth and reduce the risk of osteoporosis, therefore it is important to find other sources of this mineral within your diet.
• A mother who cuts dairy and/or soy out of her diet may be at risk of developing weak bones and osteoporosis if she doesn’t replace these foods with alternatives
• Calcium in the breastmilk is constant and comes from the mother’s skeleton. A women’s dietary intake of calcium, or supplements does not affect the amount in breastmilk.
• The calcium taken from the mother’s bones is restored within a few months of stopping breastfeeding. Studies show that women who breastfeeds are not at higher risk of osteoporosis than a woman who does not breastfeed. 

​Below is a table of dairy-free (DF) and/or soy-free (SF) food sources of calcium. Check food labels every time you buy a food, medication or supplement, as ingredients may change. Use this guide for label reading: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf

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This sample meal plan provides 1319mg of calcium across the day, and meets nutritional requirements from the five core food groups, in line with the Australian Guide to Healthy Eating (AGTHE), for a breastfeeding woman. It is a guide only. 

​Sometimes a calcium supplement is needed to ensure that you are getting the amount of calcium you need every day. Your dietitian or GP will help you decide if a supplement is necessary. 

References:
1.UCSF Health (2021). Calcium content of foods. University of California. Accessed June 10th 2021. Available from: https://www.ucsfhealth.org/education/calcium-content-of-foods
2.Nutrient Reference Values (2014). Calcium. NHMRC. Accessed June 10th 2021. Available from: https://www.nrv.gov.au/nutrients/calcium
3.Fishbein L. (2004). Multiple source of dietary calcium – some aspects of its essentiality. Regulatory Toxicology and Pharmacology. 39(2);67-80. Accessed June 10th 2021. Available from: https://doi.org/10.1016/j.yrtph.2003.11.002.
4.Gueguen L., Pointillart A. (2013). The Bioavailability of Dietary Calclium. Journal of the American College of Nutrition. 19;sup2, 119-136. Accessed June 11th 2021. Available from: 10.1080/07315724.2000.10718083
5.Australasian Society of Clinical Immunology and Allergy. Cow’s Milk (Dairy) Allergy. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
​6. Australian Guide to Healthy Eating Serve Sizes [Internet]. Eat for Health. Australia; 2015. Accessed June 23rd 2021. Available from: https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes  

This post appeared in the Australian Physiotherapy Association's Women's, Men's and Pelvic Health News Report, May 2020
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By Nicole Bando
​
Routine
Stick to your regular meals and snacks to give structure to the day, minimise time spent in the kitchen and avoid grazing. Make sure to schedule a lunch break between Telehealth or clinic patients and take it away from your workspace. Just as you normally would, pack your lunch & snacks for the day ahead. Adopt a 'kitchen is closed policy' until the end of the work or school day.
 
Snacks for mood & focus
Studies have shown that combining whole grains and protein at (meal &) snack times, promote gut health, satiety, mood & concentration. This helps to manage sugar cravings between meals. Try options such as: Vita Weats & cheese, roasted chick peas, small latte, yoghurt, nuts & a piece of fruit, peanut butter on toast or hummus, chopped vegetables and crackers. Have items such as muesli bars , boxed nuts, popcorn and fruit ready to go as convenient back-ups.
 
Small changes
Recognising that we are in stressful times helps us to be kinder to ourselves. This isn't the time to aim for dietary perfection, but rather a 'good enough' diet. What small changes can you make? Can you:

• Swap from white or wholemeal to whole grain bread for breakfast, with peanut butter, cottage cheese, eggs or baked beans, instead of jam or Vegemite?
• Add an extra serve of fruit or vegetables each day?
• Choose yoghurt and berries instead of ice-cream for dessert?
• Reduce the number of times per week where you may be choosing high sugar/high fat foods to snack on? 

Pantry recipes
Have some quick meals up your sleeve:

1. Shakshuka: Saute a small chopped onion, crushed garlic in olive oil, add a drained can of beans & 400g diced tomatoes. Make 4 small wells in the mixture, crack an egg into each. Cover pan, reduce to a simmer and cook until eggs are set. Serve with grainy toast. 
2. Shredded chicken wraps: Add shredded BBQ chicken (or tuna, scrambled egg, tofu), drained canned (fresh or frozen) corn kernels, drained red kidney (or other) beans to wholegrain wraps. Scatter with cheese and melt in the sandwich press. Serve with greens (frozen are a good option too).

Nicole Bando is a Melbourne-based Paediatric & Family Dietitian & Lactation Consultant. 
You can find her here: www.nicolebando.com, Instagram @nicolebandoapd or Facebook @NicoleBandoAPD

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INTRODUCTION TO SOLID FOODS,
By Emma McShane, Dietitian
​
The World Health Organisation states ‘infants should be exclusively breastfed for six months and after this time continue breastfeeding with appropriate introduction to solids’ (2020).
When breastfeeding is not possible, bottle feeding is recommended.
How do you know if your baby is ready for solid foods?

• Your baby has good head and neck control and can sit upright when supported
• Your baby shows an interest in food e.g. looks at or reaches out for your food
• Your baby opens their mouth when offered food on a spoon
• Your baby has an increased appetite, is feeding more often, and wants more breast milk or formula at the end of their usual feed.

 
VARIETY OF FOODS:
It is important to include a variety of foods from the five core food groups in your baby’s diet.

CEREAL FOODS
Be sure to offer a variety of grains including wheat, rice, oats and corn.
Example of cereal foods: Bread, crackers, pasta, iron-fortified cereals e.g. Weet-bix, all bran

DAIRY FOODS
Yoghurt, cheese, and cow’s milk on cereal.
Cow’s milk should not be given as a drink (instead of breastmilk or formula), for babies under 12 months of age.

MEAT AND MEAT ALTERNATIVES
Beef, lamb, poultry, well-cooked egg, fish, other seafood, legumes (e.g. lentils and chickpeas)

VEGETABLES AND FRUITS
Can be grated, cooked, pureed or mashed.

Introducing Common allergy causing foods:

• Common allergy causing foods should be included in your baby’s diet before nine months of age, as research has shown that early introduction may reduce the chance of your baby developing a food allergy.
• These common allergy causing foods are: Eggs, Cow’s Milk, Wheat, Soy, Peanut, Tree nuts, Sesame     Fish, Shellfish
• It is important to introduce one new allergy causing food at a time, early in the day, and then wait a few days to try another new food, so that you can identify any foods that may cause an allergic reaction.
• An example of how to introduce an allergy causing food, is to mix a small amount (1/4 tsp) of an allergy causing food e.g. hard-boiled egg or smooth peanut butter into your baby’s usual food e.g. vegetable puree. If there are no signs of an allergic reaction (These signs include: hives, welts, swelling of the lips, vomiting, or change in behaviour), then gradually increase the amount next time (1/2 tsp). If your baby does show signs of an allergic reaction, stop offering the food and seek immediate medical attention.
• It is important that once you have introduced these foods, to include these foods in your baby’s meals at least twice a week.

The below is a guide of solids progression, showing texture, quantity and breast/bottle feeds; it may be highly variable for each baby. You may also choose a ‘Baby Led Weaning’ approach, this involves introducing solids through appropriately textured and sized finger foods and allows your baby to explore the food themselves. There is no set way to feed your baby, so do what feels best for your family.
The above is an approximate guide for food quantities and expected number of breast and bottle feeds, this is because there are no set guidelines, as each baby will progress differently. If you feel unsure about how to introduce solids to your baby, a Children's Dietitian (Paediatric Dietitian) can provide specialised feeding advice.
  
6 MONTHS

TEXTURES
Coarsely pureed/mashed

QUANTITIES
1-2 tablespoons, twice a day (start with 1 meal and progress to 2 over weeks).

EXPECTED NUMBER OF BREASTFEEDS
Breastmilk is the main nutrition source. Continue breastfeeding on demand.

EXPECTED NUMBER OF BOTTLE FEEDS
If your baby is not breastfed, continue with bottle feeds, as this is still the baby’s main nutrition source. Slight decreases may be seen in the amounts taken.

EXAMPLE OF FOODS
Start with iron-rich foods; as your baby’s iron stores gained during pregnancy start to run low. These foods include fortified baby cereals, eggs, beans, lentils and soft cooked and pureed meat. Introducing allergy causing foods e.g. yoghurt added to pureed fruit and vegetables, Semolina porridge made with breast milk or infant formula.

6-8 MONTHS

TEXTURES
Lumpy, finely chopped, progressing to finger foods

QUANTITIES
Progressing 1-4 tablespoons of food 1-3 times/day by 8 months (slow progression) – up to ½ cup of food

EXPECTED NUMBER OF BREASTFEEDS
On demand

EXPECTED NUMBER OF BOTTLE FEEDS
3-5 times per day at 6-8 months

EXAMPLE OF FOODS
Peanut butter added to mashed foods or porridge, hummus mixed into mashed vegetables, finely shredded, soft meat added to puree vegetables.

8-10 MONTHS

TEXTURES
Grated, diced, chopped finger foods, progressing to regular menu
You’ll find your baby starts to play with their spoon. 

QUANTITIES
Up to 1 cup of food at each meal
At 9 months: 3 meals
At around 10 months: Introduce mid-meals, roughly ½ to ¾ cup of food (e.g. ½ cup full fat yoghurt with cut up banana).

EXPECTED NUMBER OF BREASTFEEDS
On demand; By 9 months: 4-5 breastfeeds

EXPECTED NUMBER OF BOTTLE FEEDS
3-4 formula feeds at 9-12 months

EXAMPLE OF FOODS
Well-cooked spiral pasta as finger food, hard-boiled egg with mashed avocado, soft grated cheese as finger food, pikelets.

10-12 MONTHS

TEXTURES
Chopped finger foods, Begins spoon feeding

QUANTITIES
Small balanced meals 3x/day e.g. 1 scrambled egg, chopped soft fruit, 1 Weetbix with cow’s milk, plus mid-meal snacks 1-2x/day.

EXPECTED NUMBER OF BREASTFEEDS
On demand; 3-4 breastfeeds per day

EXPECTED NUMBER OF BOTTLE FEEDS
600mL Bottle feed/day

EXAMPLE OF FOODS
Omelettes, cottage cheese and fruit mixed together, bread offered as toast fingers or sandwiches, homemade fish fingers, pesto sauce with pasta.

1-5 YEARS

Family foods (avoid small, hard pieces of food).  Can offer cow’s milk as a drink after 12 months.
Example foods: Scrambled eggs, Crumbed fish, vegetables dipped in hummus, pastas, cereals with cow’s milk
 
References:

1. Australian Breastfeeding Association. Breastfeeding and family foods.  ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
2. Australasian Society of Clinical Immunology and Allergy. Introducing foods and allergy prevention fast facts. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
3. NIP Allergies in the Bub. Introducing solid foods. Prevent Allergies, 2018. (Available from https://preventallergies.org.au/introducing-solid-foods/, accessed 31st May 2021).
4. NIP Allergies in the Bub. Around 6 months (not before 4 months). Prevent Allergies, 2018). (Available from https://preventallergies.org.au/wp-content/uploads/2020/10/Food-Ideas-for-Babies-around-6-Months.pdf, accessed May 31st 2021).
5. NIP Allergies in the Bub. Around 7 to 9 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-7-9-MONTHS.pdf, accessed May 31, 2021).
6. NIP Allergies in the Bub. Around 10 to 12 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-10-12-MONTHS.pdf, accessed May 31, 2021).
7. Castle J., Jacobson M.  (2013). Fearless Feeding. Jossey Bass. pp 40-54. Accessed May 31, 2021.
8. Surwald, D. (2017). Baby-led weaning & introduction of solids. Peninsula Health. Accessed June 10th 2021. Available from: https://www.peninsulahealth.org.au/2017/08/25/baby-led-weaning-introduction-of-solids/

Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children's dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.

2) When should I worry about my toddler's eating?
Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:

• exhibiting extreme fussy eating behaviours and mealtimes are very difficult
• lethargic and lacks energy for daily activities
• appears unwell

• gagging or vomiting often, or has problems with chewing or swallowing
• eating a very limited variety of foods and missing out on entire food groups
• unable to drink from a cup from around 16 months
• rejecting whole food groups or groups of foods of a similar texture
• not growing or developing as expected

 
3) How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits. 
The below strategies can help manage fussy eating behaviours:
     Parents use a consistent approach with all strategies
     Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
     Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
     Minimise distractions: eat at table, away from television, devices or toys.
     The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
     Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
     Keep meal times to a reasonable time limit and develop a routine around meals.
     A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
     Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
     Children love helping and can assist with shopping for the family’s food and simple meal preparation.
     Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
     Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
     Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
     Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.
4) Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.  

It depends. As a Melbourne lactation consultant, this is one of the top questions I am asked by lovely new mums about their beautiful newborn babies.

A breastfed baby takes in less air than a bottle fed baby & will generally bring up a burp in any position, without assistance. If your baby seems unsettled during or after a feed, try burping bub for a few minutes to see if it helps. If baby is settled, don't worry about it - trying to burp a settled baby can lead to an unhappy baby!

A bottle fed baby may take in more air during feeding. Help your baby control the milk flow with 'pace feeding'. Use a narrow neck teat, hold bub quite upright, hold the bottle horizontally and give breaks during feeding (see video link below). If baby is unsettled, burp during the feed or after. There is no evidence for/against burping; one small powered Indian study showed no significant reduction in colic in newborn babies who were burped.

When it comes to baby, there are no special rules - always look to baby for cues as to what they may need & follow your own instincts. If your baby is fussy during breastfeeding or bottle feeding, a session with a lactation consultant may help.

https://education.possumsonline.com/video/about-paced-bottle-feeding-renee-keogh

By Nicole Bando, May 13, 2021

Myriad colourful, fizzy, chewable children's vitamins line pharmacy shelves, causing parents worry that their child may be lacking in vital nutrients. As a Paediatric Dietitian & Lactation Consultant, I am often asked 'should I give my child a multivitamin?' In most cases, a healthy child who is eating across the food groups does not require additional supplementation. Many foods are fortified with vitamins & minerals, so your child may be consuming more of these nutrients than first considered. There is no evidence that additional vitamin and mineral supplementation benefits health. In fact, taking an excess of certain vitamins, such as fat-soluble A, D & E can have negative health effects. Fat-soluble vitamins accumulate in the body, unlike water soluble vitamins, such as Vitamins B & C, where excess is generally filtered out through the urine (N.B. there is still potential for toxicity in large quantities). For example, excessive Vitamin A in children can cause skin irritation, vomiting & an enlarged liver.

Ultimately, the best advice is to make sure that your child is receiving enough nutrition from food & supplements cannot replace the value of whole foods. If your family could do with some guidance to make sure that everyone is maximising their nutrition potential, see a family dietitian. 

In certain cases, vitamin supplements are necessary, such as:

• Vitamin D deficiency (darker skin, inadequate exposure to sunlight, exclusively breastfed babies)
• Iron deficiency, which may occur in extremely fussy eating or vegan/vegetarian diets
• Vegan/vegetarian diets
• Certain diseases which may reduce absorption of nutrients
• Multiple allergies, where whole food groups can be excluded
• Slowed growth
• If needed, a blood test can show if there is a deficiency in certain nutrients (e.g. iron, Vitamin D).

Your dietitian or paediatrician will advise if this is the case. Products are roughly categorised into multivitamin preparations, single nutrients (e.g. iron), probiotics and then marketing categories, such as 'immune boosting' or 'brain development'. Here's a brief overview of a few popular multivitamins:

• Centrum Kids & Swisse Children's Multi: if needed, these are both good multivitamin options that give a general coverage of key nutrients, including small amounts iron, zinc and negligible calcium. Centrum Kids contains Vitamin A in excess of the recommended daily intake for children (RDI). Swisse Children's Multi contains a large proportion of the RDI. 
• Blackmores Super Kids Multigummies: Mostly B vitamins, small amount of zinc & iodine. No iron, calcium or Vitamin A. Sugar-free.
• Nature's Way Vita Gummies: B vitamins, Vitamin A close to RDI. Small amount Vitamin D, some E. No calcium, iron, zinc. Most children get enough B vitamins, so these vitamins would generally be lost in urine. Contain sugar. 

What's the bottom line?
Unless your child fits into one of the above categories, or you have concerns that their diet may be inadequate, a multivitamin is likely not necessary. Seek professional guidance. 

Acknowledgements: 
Rodney Whyte, Senior Pharmacist, Monash Health

Sources:
NHMRC, Nutrient Reference Values for Australia and New Zealand
Royal Children's Hospital, Vitamin A: https://www.rch.org.au/immigranthealth/clinical/Vitamin_A/
Dr Anthea Rhodes, RCH Paediatrician & Director, Australian Health Poll https://blogs.rch.org.au/news/2016/09/13/blog-vitamins-and-kids-do-they-really-need-them/

As a Melbourne-based Lactation Consultant, I offer home visits or clinic consultations for an initial 1.5 hour visit. I often think I have the world’s best job, meeting babies and their wonderful parents. It is a privilege to be involved in a new family’s most precious, earliest moments. I am a health professional (Family & Children’s Dietitian) with additional specialist training in breastfeeding management & counselling, baby sleep and settling.

I will aim to understand your specific goals and concerns, such as: damaged or sore nipples, latching problems, worries about oversupply or low supply, baby’s growth, mastitis, thrush, blocked ducts, how to mix feed & which formula to use, how to introduce solids & general questions, such as ‘how do I know when my baby is full?’ or ‘is my baby getting enough milk?’ or ‘is my baby’s poo normal?’. I will take a detailed history about your pregnancy and birth and the overall health of mum and baby. I will assess how your baby is growing, by plotting their weight, height and head circumference on growth charts and then explain the charts to you. I assess baby's appearance, behaviour, sleep & output (number of dirty and wet nappies). I understand that newborn sleep & feeding patterns can be unpredictable and I will guide you with questions to enable an accurate assessment. 
​
I will examine your breast and nipple health, followed by observation of a breast or bottle (or both) feed & an expressing session (if needed). I assess how the baby is positioned, feeding, breathing and swallowing at the breast or bottle and will explain to you what I see. During the feed, I will make suggestions to improve the latch for a comfortable and efficient breastfeed and have you and your baby fitting together like a gorgeous puzzle. I will also have a look inside your baby’s mouth, to check for tongue tie & assess your baby’s sucking pattern.

As a Dietitian, I might also ask about your eating habits, to make sure that you are looking after yourself, as rapid weight loss, or not eating properly can also affect supply, and impact overall energy levels and coping. In the early days of sleep deprivation with a newborn baby, a mum needs all the energy she can get. Here are some quick tips on easy meals and snacks for new families.

I will talk you through every part of the assessment and answer all your breast & bottle feeding, baby sleep and settling questions and provide you with options for management to best fit you and your family. We will make plans for follow up as needed. You will be provided with written recommendations, resources & local support information. With your consent, I will liaise with other members of your healthcare team, such as your GP or paediatrician. I phone my families within a few days of the initial lactation consultation to see how things are developing. I would love the privilege to meet you and your little one, please contact me on 8840 1652 to discuss your family’s needs.  

Image courtesy of Colin Maynard on Unsplash

Include Grains, Dairy, Fruit, Vegetables & Protein each day to encourage learning, concentration, healthy growth and sustained energy. 

The main event (sandwiches)

• ​Wholegrain roll with chicken or lean ham, cheese, lettuce and grated carrot.
  
• Wholegrain wrap with shredded cheese, tuna, chopped tomato and cucumber
  
• Wholemeal pita with falafels, hummus, corn kernels and cucumber pieces
  

Sandwich alternatives:

• Pasta spirals, cherry tomatoes, grated cheese, tuna and corn kernels
• Minestrone soup and a small grainy bread roll.
• Homemade pizza on wholemeal pita (lean ham, cheese, capsicum, tomato)
• Leftover rice with shredded chicken, grated carrot & zucchini.

Snacks:
Cheese & crackers
Yoghurt
Popcorn
Edamame
Roasted chickpeas
Boiled egg
Flavoured tuna
Baked beans
Mini wholemeal pita & avocado
Trail mix: seeds, a few pieces dried fruit, puffed rice or corn.
Pasta spirals with grated cheese

Fruit and vegetables:
Chopped fruit, (1 piece for lower primary, 1.5-2 pieces for upper primary)
Sliced vegetables (corn on the cob, cherry tomatoes, carrot, snow peas, beans, capsicum, baby cucumbers)

By Nicole Bando, Family & Paediatric Dietitian & Lactation Consultant
​
Constipation in babies occurs when a baby's poo or stool in hard and difficult to pass. I spend a lot of time talking baby's poo, as what goes in must come out! There is variation in how often babies poo, related to feed type; breast, formula or mixed, age & stage. 

A breastfed baby: In the first 6 weeks, baby might poo 1-5 times per day or as infrequently as every 5 days or more. Their poo has a cottage cheese, mustard appearance and is soft, runny and easy to pass. A breastfed baby does not need additional water in the first 6 months. If baby's poos are hard & painful to pass; this can be a sign of inadequate breast milk. Offer additional feeds. This can also be done in hot weather, or if baby has a temperature. 

A formula/mixed fed baby's stools will be firmer and a green/brown colour; baby may poo 1-2 times per day. This is because the protein in formula (cow's milk protein) differs to human breastmilk protein. If baby's poos are crumbly, pellet like or dry, ensure that you are making the formula up as per instructions. Additional water is generally not advised in the first few months of life, and extra feeds may be required. See your doctor if concerned.


Solids: At around 6 months, when solids are introduced, baby may take a few sips of water or expressed breast milk from a sippy cup at meal times. Introduce fibre containing foods, such as fruit, vegetables, wholegrain breads & cereals.  If baby's poos are hard to pass, stewed pear, apricots or prunes, or diluted prune juice can be offered a few times a week.

When to seek help: In the early months, constipation, poor growth, a very unsettled baby and blood or mucous in the poo are all indicators to seek medical attention. If you are concerned, check in with your doctor.

Photo by Bruna Branco on Unsplash

Article by Nicole Bando, APD & IBCLC, March 15, 2020
​
Nutrition & Immunity
Let’s talk about how you can optimise your nutrition to enhance immunity, based on sound scientific evidence. When it comes to supplementation, there is unfortunately no magic pill known to boost immunity and prevent infection. If anyone is trying to sell you such things, save your dollars and hit up the fresh fruit and vegetable section of your local shops instead. Studies have shown that a daily 200mg dose of Vitamin C can reduce the duration of a cold by about half a day, but there’s little other evidence to encourage vitamin or mineral supplementation unless you have a true deficiency, as diagnosed by a medical professional.

What is the immune system?
Put simply, the immune system consists of a multitude of organs, cells and proteins designed to fight infection (microbes). Skin is the body’s first barrier and other defences include the gut microbiome, mucous, saliva, tears, enzymes and stomach acid. The bone marrow, spleen and lymphatic systems all form part of our immune system.

White blood cells are made in the bone marrow and certain types, such as T and B lymphocytes move through the bloodstream and tissue looking for microbes (viruses, bacteria, fungi, parasites) to attack. These cells have ‘memory’ of microbes they have encountered before, helping your immune response to react more quickly to repeat infections.

The immune system also produces antibodies, specific proteins made to fight a foreign body or antigen. Antibodies attack and destroy these foreign invaders with the help of other cells and chemicals. For more information, click here:

What we know:

To be clear, the best methods to stay healthy are as per CDC and WHO guidelines: frequent & effective hand washing, avoid touching your nose and face, avoid close contact with anyone demonstrating flu-like symptoms, seek medical advice early if you develop symptoms and cover your nose and mouth if coughing and or sneezing. Latest updates here:

Is it safe to breastfeed?

If you are a breastfeeding mother, it is safe for you to continue doing so even if you have Coronavirus. You are producing vital secretory IgA antibodies (and myriad immune factors) that will transfer via the breastmilk to your baby to provide immune protection and optimise baby’s immune response. Wear a mask around your baby, wash your hands with soap regularly, including before breastfeeds. If you need to be isolated from your baby, it is safe to express your breastmilk for your baby to drink. Remember that any amount of breastfeeding confers immune benefits, so babies who are mixed fed will also receive protective immune factors. Click here:

A word on malnutrition:

There is evidence to show that malnutrition reduces immunity and can increase risk of infections. Malnutrition may occur in vulnerable groups, such as the elderly or those with multiple medical conditions, or the very underweight. It is also possible to be malnourished at a high body weight due a high energy but low nutrient intake. These individual situations require attention from both a doctor and dietitian. If you are fit and well and healthy, look out for those in our community who may be at greater risk and would benefit from a cooked meal or help with their food shopping. If we can shop as per usual and avoid panic buying, there is more than enough nutrition (and kindness) to go around.

Which nutrients?

These key nutrients have been shown to have a role in immunity:

• Vitamin B6  (breads, cereals, vegetables, eggs, fish): involved in red blood cell formation and metabolism of protein
• Vitamin C (citrus, tomatoes, broccoli, berries): antioxidant, involved in collagen, maintaining teeth, bones, gums and promotes wound healing.
• Vitamin E (peanut butter, almonds, sunflower oil and seeds): antioxidant
• Magnesium (whole grains, legumes, nuts, seeds)
• Beta-carotene (carrots, sweet potato, green leafy vegetables): coverts to Vitamin A (retinol), assists with healthy growth, vision, skin and mucous membrane (part of body’s defence against germs) integrity
• Zinc (whole grains, dairy, red meat, legumes, nuts): wound healing, forms part of enzymes (some involved in immune health)
• Vitamin D (oily fish, eggs, margarine, best source: sunlight): bone health, healthy cell formation, immune function.
• Antioxidants are chemicals found in fruit, vegetables, wine and tea and are part of our body’s defence system against free radicals (unstable molecules that cause damage to proteins such as DNA and cell structures).
• Unless you are deficient in these nutrients, taking supplements is of no benefit. As you can see, these nutrients cross a variety of foods from all group (dairy, meat/alternatives, veg, fruit, whole grains), so a balanced diet is key. Remember that small steps to increase your intake of these foods are all positive.
• Click here for a sample balanced day: 

What is the bottom  line?

General health:

• Practice good hand hygiene and social distancing.
• Rest and get plenty of sleep
• Exercise
• Try to minimise stress levels
• If you drink, do so moderately, avoid if pregnant/breastfeeding. Revised NHMRC Guidelines suggest less than 10 standard drinks per week 
• Don’t smoke

And when it comes to nutrition?

• Eat the rainbow! Aim for 5 serves of vegetables and 2 of fruit (frozen and canned are good options) 
• Include wholegrains: breads, cereals, rice, pasta, oats, quinoa, barley, etc.
• Include lean sources of protein: meat, chicken, soy, eggs, nuts, dairy, fish, legumes
• Add small amounts of good fats, such as nuts, seeds, avocado, olive oil
• Reduce your intake of sugary foods and drinks
• Get your daily dose of Vitamin D in the sunshine at safe times or via supplementation if your levels are low (a blood test will show this)
• Here’s a recipe to boost your intake of nutrients

Other references: Saxelby, C 2012, Catherine Saxelby’s Complete Food and Nutrition Companion, Hardie Grant Books, Melbourne.

By Nicole Bando, APD, IBCLC

• Make a breakfast omelette - throw in a handful of veg such as spinach, capsicum, mushrooms. Add lean ham, cottage cheese or feta.
• Snack on a small can of corn or 4 bean mix
• Snack on a cob of corn
• Grate loads of leftover veg to make vegetable fritters, recipe 
• Snack on vegetables sticks & dip
• Try roasted chickpeas/ fava beans or edamame as a snack
• Munch on celery & cream cheese
• Roast a big tray of vegetables and use in lunches
• Grate some carrot into your sandwich
• Load some raw chopped mushrooms into a wrap with tuna and avocado
• Mix washed baby spinach leaves through pasta or rice
• Make a loaded veg soup and eat throughout the week
• Stock up on frozen veg and add a couple of handfuls to your meals
• Add some sliced tomato and basil to your morning toast with cottage cheese or avocado instead of vegemite
• Add a tomato and handful of greens to your morning eggs

By Nicole Bando, Dietitian & Lactation Consultant

Cow's milk: an excellent source of protein, calcium, phosphorous, magnesium, Vitamin A & 12, lactose, zinc. Choose full cream, 3.8% fat (unless you have diabetes, high cholesterol, heart disease or would like to lose weight, then opt for low-fat or skim (0.15-1.5% fat)

Lactose free cow's milk: A good option for those who lack the enzyme needed to digest the natural sugar in milk, lactose.

A2 milk: Cow's milk contains A1 & A2 proteins and a couple of studies suggested that the A1 protein increased gut inflammation, some cows have been bred to produce only A2 protein milk. Larger studies did not support this earlier finding and there is no proven benefit to drinking A2 milk. For some who experience digestive discomfort, it may be worth a try. For the rest of us, at double the price, there is no benefit.

Soy: The most similar nutritionally to cow's milk and the best choice if opting for plant-based unless you have a soy allergy. A good source of protein, look for a soy milk with added calcium, Vitamins A, B1, B2, B12. Lactose, gluten free.

Almond: Low in protein, carbohydrates and calories. If allergic to dairy or soy, choose an unsweetened brand with added calcium. Lactose, gluten free. Rice: high in quick release carbohydrates, low in protein, vitamins and minerals. Lactose, gluten free.

Oat: Contains some protein, fibre, look for unsweetened varieties with added calcium & Vitamin B12. Not gluten free. Next best option after cow's and soy milks.

​Coconut: High in saturated fat, low in all nutrients, including protein, vitamins and minerals and carbohydrates. Drink occasionally for the flavour in smoothies (choose unsweetened with added calcium) or curries. *If going plant-based, look for milks with added calcium (100mg per 100mls). *If your child has an allergy to dairy or soy, seek advice from a paediatric dietitian to ensure adequate nutrition for growth. ere to edit.

By Nicole Bando, Dietitian & Lactation Consultant, November 2019

I’ll start by saying that I’m all for encouraging people to eat healthier food. There is absolute scientific consensus that we cannot sustain a future population of 10 billion people with our current diet and food production methods. An urgent, systematic review of how we produce, transport and eat food is required. Game Changers rightly touched on the global impact of current food production. However, should you obtain nutrition information from a Netflix documentary? I’d say no, and here is why:

Let’s talk ‘plant-based’:
The term ‘plant-based diet’ is new and what does it mean? Game Changers did not make this clear. If I took my dietitian hat off, the main message I received was to eat lots of vegetables and maybe some beans, absolutely no meat and I’d be good to go. But the reality is far more complex than that. It is true that a vegetarian or vegan diet confers many health benefits (lower risk of heart disease, stroke, diabetes, lower body weight). However, this diet must be carefully planned or serious deficiencies from lack of key nutrients such as iron, Vitamin B12, zinc, iodine and omega-3 fatty acids can develop.

The long-term consequences of deficiencies include anaemia, osteoporosis (brittle bones), loss of nerve function, depression and long-term cognitive impairment. At vital times such as pregnancy and breastfeeding, inadequate omega-3 fatty acids (found in fish, chia, flaxseeds, walnuts, microalgae) can impact a baby’s brain development. Serious stuff, no?

Athletes have far greater requirements than the general population, and risk inadequate iron, energy and protein intakes. This impairs recovery, increase injury risk and has long-term health consequences. The female athlete is risk of consequences including irregular periods, infertility, osteoporosis and a host of cardiovascular and mental health side effects.

None of these risks were mentioned, which is why it’s best to seek advice from a trained health professional, rather than Hollywood. I will give kudos to Game Changers for using some pretty good party tricks, such as finding the strongest man in the world who only eats plants to move some heavy stuff, measuring nocturnal erections of college students and centrifuging blood after a meat vs vegetarian meal. All very convincing, but a little lacking in scientific depth.

It's a little extreme to compare the meat industry to the tobacco industry. Whilst the science does tell us that a diet heavy in processed meats can increase the risk of certain cancers, meat isn’t out to get us. I’m confused, aren’t we the ones hunting down the animals and putting them on our plates? My issue is the demonising of one food. Our health crisis is related to myriad factors, including added sugars, salt, overall saturated fat, caloric intake and lack of enough of the good stuff, mainly fruits, vegetables and whole grains. Even that is oversimplifying matters.

The bottom line?

• If this documentary made you consider changing your diet to eat more plant foods and reduce meat, processed foods and sugar, awesome.
• The Eat Lancet Commission gathered 37 of the world’s leading scientists produced a global document that addresses the environmental and health crisis we face as a planet, with food as the driver for change.
• It is ok to keep some meat on your plate, try to reduce total to 300g per week. Include dairy, eggs and fish.
• Base your diet on plant-based foods: nuts, legumes, fruit, vegetables, whole grains
• Include good fats
• Reduce added sugars
• And please, seek advice from a university qualified nutrition professional if you are considering a vegetarian or vegan diet, especially if you are in a vulnerable category (pregnancy, breastfeeding, child, adolescent or athlete).
• For some hard-hitting evidence-based information, explore this: www.eatforum.org
• And a documentary that is right on the money? 2040 by Damon Gameau: www.whatsyour2040.com