What to know about breastfeeding

Despite the fact that we were all babies once, all that knowledge about how and what we ate is all but forgotten. A shame, really, because it’s shockingly hard to get reliable advice online about how to care for one. Especially when it comes to breastfeeding.

Between bloggers shaming women who don’t (or can’t) breastfeed and formula companies pushing their latest product, it’s easy to misunderstand the value of breast milk and breastfeeding for both the birther and the birthed. Though breastfeeding doesn’t come naturally to many women, research has shown the practice has undeniable benefits: like protection from certain diseases, improved insulin response, plus a boosted immune system. But breastfeeding is far from black and white. When to introduce solid foods, sensitive items like peanuts, and what to do if you can’t breastfeed altogether are all valid points that deserve the internet’s close attention. Here’s what the science says.

How long should I breastfeed for (and do I have to)?

Most of the top health organizations in the world recommend exclusively breastfeeding for the first six months of a baby’s life. Research shows that breast milk may help babies avoid diseases later in life, like obesity and diabetes. Though the exact mechanism isn’t known, experts think the milk alters insulin and other hormonal pathways in babies, changing the way their little bodies respond to incoming calories Breast milk also contains beneficial bacteria, which researchers are learning is incredibly important for a developing baby’s gut. The practice is also linked to higher intelligence. More babies who are breastfed survive their first year of life, and their mothers are less likely to have postpartum hemorrhages or breast, uterine, and ovarian cancers. Breast milk also provides babies with an immune boost, helping to protect them from stomach bugs, ear infections, pneumonia, and urinary tract infections among others. That’s because it contains immunoglobulin A, an immune molecule that helps in the first line of defense against incoming pathogens, plus antimicrobial proteins and other immune factors that help babies develop the ability to fight off infections.

For all these reasons, the World Health Organization (WHO), the American Association of Pediatrics, and the American College of Obstetricians and Gynecologists (ACOG) all support breastfeeding for at least six months.

But that’s not to say all moms do it.

A 2012 report from the Centers for Disease Control found that only about three quarters of babies in the U.S. has ever been breastfed, and just under half had been breastfed through six months. Plenty of women stop breastfeeding early to go back to work, especially low-income women who don’t have the luxury of long maternity leaves and flexible jobs that allow pumping at work. Others may be under the impression that formula is just as good as breast milk—companies like Nestlé have spent millions in advertising exactly that message.

Still others may have legitimate medical reasons that they cannot breastfeed. The WHO lists only a few of these, including HIV infection, necessary maternal medications that aren’t safe for infants (like psychotherapeutics or chemotherapy), tuberculosis, substance use (like alcohol, nicotine, cocaine, amphetamines, etc.), or other serious maternal illnesses. Some babies may also not be able to handle breast milk. Infants who have phenylketonuria need a formula free of phenylalanine, others may need galactose-free or leucine/isoleucine/valine-free formulas. These babies might be at higher risk for the diseases and infections mentioned earlier, but the risks of continuing to feed them breast milk are clearly not worth the protective effects.

Breastfeeding has lots of benefits, but it can also be challenging. Many women have trouble learning how to get their milk flowing and their baby latching, and it can be painful at times, which is why lactation specialists exist. . As the WHO notes, “while breastfeeding is a natural act, it is also a learned behaviour.” It may take time and energy, and a considerable amount of frustration, to achieve.

When should I introduce solid food?

As we said, most of the top health agencies recommend no solid food before six months of age. But that being said, there are some studies that suggest potential benefits to introducing some foods earlier. A recent study in JAMA Pediatrics tracked 1,303 infants from age three months to three years and found that early introduction of solid food (between four and six months) helped kids sleep longer and more consistently throughout the night. However, previous research has found just the opposite, like this 2011 study. One researcher at Swansea University cautioned against changing feeding behaviors in response to this latest study, noting that there are plenty of reasons to avoid solid foods before six months. For one, babies’ digestive systems are still developing (plus they can’t even hold their own heads up).

Another study suggests that early solid foods help decrease the risk of developing eczema, asthma, and allergies generally. Yet another found that introducing solids before four months was associated with obesity later in life, but only among babies who were fed formula. Breastfed babies had no change in their obesity risk.

All of this sounds pretty contradictory, and it kind of is. The thing every health organization seems to agree on, though, is that regardless of when you introduce solids, you should try to keep breastfeeding for as much of the first year as you can manage, and even into the second.

When should I give my baby allergenic foods like peanuts?

Guidelines used to say you should wait to introduce kids to peanuts, and maybe even other allergen-containing foods, until kids were three years old. That recommendation was based, unfortunately, on intuition rather than knowledge. When they finally had high-quality data, allergists revised that recommendation to say that babies should actually be introduced to these foods when they are between the ages of four and six months. This early introduction helps their immune systems learn that the proteins in peanuts (and eggs, and other allergenic foods) aren’t harmful. Even children who might otherwise be at high risk for developing food allergies, like babies with eczema, should be introduced early. Parents may feel more comfortable doing that at a doctor’s office, where if their baby does react there are healthcare professionals around to help. Either way, early introduction is key.

If you’re concerned, you can find an allergist near you or talk to your pediatrician or obstetrician. Really, that’s the best advice for most of your breastfeeding questions—talk to someone who knows your personal health history and can help you make a decision. It’s their job to listen to you and guide you. If they’re not, find another one (if possible). Healthcare professionals should be able to help you and your baby have healthy lives, no matter what struggles you’re facing.