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Breastfeeding your baby is the first line of defence against infection.

Breast milk contains all the major nutrients your baby needs for his growth and development. Additionally, it often contains helpful substances such as antibodies and enzymes (which are not present in infant formula) that protects baby from diseases and enables your baby to digest major nutrients better.

Best for baby

• Breast milk contains all the nutrients your baby needs in the right proportion.
• It boosts the immune system, reduces risk of getting acute respiratory tract infections, pneumonia, diarrhoea and allergies.
• Breastfed babies are smarter
• It reduces risk of chronic illnesses such as obesity and Type 2 diabetes

Best for mum

• Breastfeeding promotes bonding between mother and baby
• It helps mums get back into shape faster as it helps to burn extra calories
• It speeds up the recovery as it reduces postpartum bleeding
• It reduces risk of post-menopausal breast and ovarian cancer
• It may reduce the risk of hip fractures and osteoporosis in the postmenopausal period

Exclusive breastfeeding means that baby is given only breast milk. No water, food or other types of drinks are necessary. Exclusively breastfed babies receive the greatest health benefits from breast milk. Other food or drinks, even water, can interfere with breastfeeding because it fills baby up so he nurses less. Babies need the nutrition and calories in breast milk to grow. Water, for instance, has none of these.

Ready … set … go!

For many women, the first signs that they are pregnant may be the changes to their breasts. They may experience tenderness, swelling and the darkening of nipples and areolas (the circle of skin around the nipples), all signs that the body is getting ready to supply milk to the coming baby.

The small bumps on the areola enlarge in readiness to produce a natural oil that will clean, lubricate and protect the nipple during pregnancy and breastfeeding. This oil contains a bacteria-killing enzyme, and makes breast creams unnecessary.

As you can see from the top diagram, the duct that holds the milk is just below the areola. Hence, it is important to latch baby on the areola to withdraw as much milk as possible, not on the nipple which is just an opening for the milk to flow out (it has 15-20 openings).

When baby suckles, the stimulation will trigger the brain to release a hormone called prolactin, which causes the milk cells in the breast to produce milk.  Hence, the earlier and the more frequent a baby suckles, the faster milk will be produced.

Prolactin levels are highest at night. Therefore, it’s also important to breastfeed your baby at night to maintain good milk supply.

Another hormone called oxytocin is also released and it causes the muscles surrounding the milk cells to squeeze the milk out and flow to the milk ducts.  This is called the letdown reflex, during which milk flows out of the nipple. It also helps the mother relax. Let down may take several minutes, especially when the mother is tired, in pain or stressed.

If the breasts are not emptied frequently, they can stop producing milk. Breast size has nothing to do with milk production. The more you nurse, the more milk is produced.

The composition of breast milk is very unique in the sense that it fulfils the babies’ needs according to their stages of development. It changes from colostrum to transition milk to mature milk.

Colostrum

This “first milk” is present before birth and up to a week after baby is born. It’s thick and sticky with a colour that varies from pale cream to orange. This easily-digested milk is rich in protein, vitamins,  minerals and antibodies for protection, thus known as “the first immunisation”. It encourages early bowel movement, which helps to minimise neonatal jaundice. No wonder colostrum is sometimes referred to as “liquid gold”.

Transitional Milk

This creamy milk is produced, following colostrum, for approximately two weeks. The quantity of milk increases, and composition changes. There is less proteins and antibodies in this milk, but more fat, lactose and water, hence it may look more watery than normal milk but rest assured, it is enough to fulfil the requirements of the newborn at this stage without overloading their immature organs. At this stage, it’s important to nurse frequently to avoid engorgement.

Mature Milk

This final milk is produced near the end of the second week after childbirth. About 90% is water, necessary to maintain the hydration of the infant; while 10% comprises carbohydrates, proteins and fats, in the right proportion, all necessary for both growth and energy, as well as antibodies, growth factors and enzymes.

Mature milk consists of foremilk and hindmilk. Foremilk flows at the start of feeding and looks like barley water. It contains water, vitamins and protein. Hindmilk flows after the initial letdown and is bluish white. It contains high levels of fat and is necessary for weight gain.

As a particular feeding progresses, the fat-content of the milk increases. The amount of time it takes to receive his fill of the higher-fat milk at the end of the feeding varies from baby to baby. Therefore, it is important NOT to switch breasts while baby is actively nursing. Allow baby to feed on one breast at a time instead of changing breast during feeding, so that he will be able to get both the fore and hind milk.

Breast milk is more easily digested than formula milk, so baby will need to be breastfed more often than if he were formula fed.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

• Not true.
• There is no known point at which breast milk becomes nutritionally unimportant. Breastfeeding continues to act as a source of profound comfort and security, laying the groundwork for a confident, happy, and healthy future. It’s advisable for mums to continue breastfeeding until baby is up to 2 years old.

• Not true.
• Getting kids to eat foods that they might not like at first can be extremely frustrating. Research has shownthat some children have to sample a new food 10 or more times before they accept that food. So, before you remove an essential ingredient, try it again in a different recipe. It can often be good to serve it alongside something they’re already familiar with to make it more “friendly” and acceptable.

• Not true.
• Children who are forced to clean their plates override their natural ability to monitor how much food they need to grow at a healthy rate.Don’t worry about your child going hungry. Infants and toddlers are able to self-regulate their energy needs and intake. Serve your child small portions and let them ask for more if they are still hungry.

• Not true
• Fat is a very important nutrient in children’s diet as it provides the essential fatty acids, serves as the most concentrated source of energy for rapid growth and development, acts as a vehicle for the absorption and transportation of the fat-soluble vitamins (A, D, E and K), and is involved in many important body metabolic processes. Putting toddlers on a low-fat diet is therefore not recommended as this may adversely affect their growth and development. However, this does not mean that the child should be given excessive fat as this may lead to childhood obesity. A balanced diet, which includes appropriate amounts and types of fats is essential for growth and development of young children.

• Not true.
• Sweets should be a once-in-a while treat, not a regular “solution” to “encourage” picky eaters to have their vegetables. Once parents get into the pattern of bribing their children with dessert, the association of healthy food with “bad” food becomes ingrained. Having said that, depriving children of sweets will encourage them to eat more sugary treats outside of the house. Instead, offer healthier alternatives like fruits or natural sweeteners like honey.

• Not true.
• The period from birth to two years is a critical window for the promotion of optimal growth, health, and behavioural development. Children who learn to make poor diet choices are at more risk of becoming overweight or obese, and these habits are learned younger than parents might think. Don’t use food, especially foods that are high in fat, sugar and salt, or foods with low nutritional content, as a comfort tool. Build good habits by finding the real reasons why your child is upset and treating the problem appropriately. Food should only be used to relieve hunger.

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Healthy Spoonfuls for Toddlers. Petaling Jaya: Mother’s Smart Choice.

Understanding food labels can help you choose the right type of food for your toddler.

• Check out the nutrition claims on the front of the pack

• Look at the Nutrition Information Panel or NIP (usually found at the back of the pack).

  

• Look at the amount of energy and other nutrients in the food. Consider how these nutrients contribute to the total daily intake and nutritional needs of your toddler.
• Make food choices based on overall nutrient content, not merely on one or two nutrients.

Check Ingredients List

• Ingredients present in the highest amount are listed first.
• If you toddler has an allergy, check carefully to make sure there are no ingredients that would trigger an allergic reaction.
• There are other different forms of sugar, fat, oils, and salt on food labels.

• Compare the Nutritional Information Panel (NIP) of different brands of a food product and choose the one with lower/lowest amount of fat, sugar and salt, and higher/highest in fibre. Find the brand that best meets your toddler’s nutritional needs. Compare different brands based on every 100ml/100mg of the product.
• Look at the nutrition claims of each product. While such information may be useful in describing the nutritional content, do not purchase it just because it has a “high in” or “free of” claim. You will need to look at the whole nutrient profile based on the NIP
• For each claim such as free or low in fat, sugar and sodium, the food law has a stipulated requirement. Each product must meet that requirement to make that claim.

<Insert video “How to read food labels”>

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Healthy Spoonfuls for Toddlers. Petaling Jaya: Mother’s Smart Choice.

Your toddler can start eating table foods at around 12 months old. This is, basically, what the rest of the family is having for meals. In order to ensure that he develops a taste for nutritious meals, healthy eating habits must be encouraged from the word go.

• Get your toddler involved in food preparation by taking him grocery shopping.
• Familiarise him with mealtimes by showing him how food is prepared and cooked, and letting him help to set the table. It could be something as easy as placing spoons on the table, graduating to more complicated stuff as he gets older.
• Your toddler has a small stomach and will get hungry quite quickly, so aim to feed him 4 to 5 main meals, plus 1 to 2 snacks a day.
• While ensuring he gets nutritious food, also consider your toddler’s food preferences and the amount he eats. This allows mealtimes to be less stressful and more enjoyable.
• Make meals and snacks fun by arranging foods in interesting ways such as a smiley arrangements that will attract his attention.
• Be a good role model and eat healthily – your toddler will follow your lead. Have your toddler eat with the family as much as possible to allow him to learn good table manners and good eating habits.
• Encourage your toddler to self-feed. This helps him to fine-tune his motor skills, and learn to be independent.
• Well-balanced home cooked meals are a priority. Prepare these meals, with a variety of food types, guided by the Food Pyramid of Malaysia. This will ensure that your toddler receives all the nutrients he needs for growth and development. It also helps to introduce him to different tastes and textures, increasing his ability to accept a wide range of nutritious foods.)

Do’s

• Keep mealtimes happy and relaxed.
• Eat together as a family to allow your toddler to learn good table manners from the adults present.
• Introduce self-feeding to your toddler to encourage him to be independent.
• Serve your toddler a variety of foods for different tastes and a balanced intake of nutrients.
• Repeat offers of the same food, at a later time, if your toddler refuses to eat it the first few times.

Don’ts

• Turn on the TV, phone and tablet during mealtimes as they are distracting.
• Force your toddler to eat everything on the plate. Instead, listen to his hunger cues.
• Serve your toddler hard, hard-to-chew or large chunks of food.
• Add salt or salty sauces to your toddler’s food.
• Use food such as sweets as a reward for good behaviour as this does not encourage a healthy attitude towards food and eating.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Healthy Spoonfuls for Toddlers. Petaling Jaya: Mother’s Smart Choice.

Variety is key.

• Pick foods from each food group in the Malaysian Food Pyramid for a balanced meal.
• Always select different food items within each food group to ensure variety and a balanced intake of different nutrients.

Limit oily and high fat foods

• Instead of frying, try other ways such as baking, grilling, air frying, stewing and steaming.
• Replace animal fats (saturated fats) with vegetable oil when preparing foods. Try blended vegetable oil high in PUFA such as palm oil blended with soya oil.
• Trim visible fat from meat and remove skin from poultry before cooking.

Limit use of processed meats

• Meat products like sausages, nuggets and cold cuts should not be eaten more than once a week.

Limit salt intake

• Allow your toddler to develop a liking for the natural taste of foods by not adding too much salt to his meals.
• Cut down or halve the use of salt and sauces in cooking.
• Replace salt with herbs and spices to add a variety of flavour to foods, as well as enhance natural flavour.

Use less sugar

• Substitute sugar with flavourful spices such as nutmeg, vanilla or cinnamon.

Encourage nutritious snacks

• Such as fruits and vegetable.

Serve snacks two hours before main meals (see reference 3 for more snack ideas).

Make meals more appealing

• Use moulds, as well as interesting tableware and cutlery to make meals more appealing.
• Arrange foods in interesting shapes, such as smiley face, to make meals and snacks fun.

Prepare home cooked meals

• They encourage the whole family to eat together more often.
• There is more control over the type and amount of ingredients used, as well as the cooking methods employed.
• Some studies suggest that children who eat home cooked food often with their family grow up with less risk of developing unhealthy eating habits or weight problems.

Useful Download(s)

• Dining out with your toddler

Insert video: Demo “how to prepare healthy meals for your toddler”

• As a toddler has small stomachs, he will get hungry quite quickly. Aim to feed him 4 to 5 main meals with 1 to 2 snacks, daily.
• The energy requirements for active toddlers are 980kcal (for boys) and 910 kcal (for girls).
• Sources of energy should be mainly cereal and cereal products, as well as tubers.
• Toddlers can start drinking cow’s milk. Offer this as a snack instead of main meal. Breast milk is still the preferred choice as breastfeeding is recommended until up to 2 years of age.
• When preparing meals, select one food from each food group from the Malaysian Food Pyramid.
• A child’s serving size should be approximately one-quarter of an adult’s. For example, a serving of vegetables for toddlers would be about 1 to 2 tablespoons. For meat, toddlers need a serving the size of their palm.

Useful Download(s)

1. Food pyramid and serving sizes for toddlers
2. Sample meal plan for toddler 1-2 years old

By your baby’s first birthday, he should be consuming a wide variety of solid foods. While the main source of energy should come from solid foods, breast milk continues to provide nutritional and immunological benefits to baby. Breastfeeding also acts as a source of profound comfort and security, laying the groundwork for a confident, happy, and healthy future. Therefore, it is recommended to continue breastfeeding your baby up till 2 years of age or beyond.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Healthy Spoonfuls for Toddlers. Petaling Jaya: Mother’s Smart Choice.

• Probably not.
• There’s no evidence that starting solids helps baby sleep any better than he did before. So, do not give solid foods to your baby earlier than 6 months with the hope that he will sleep longer. This practise is not advisable because starting solids too early will have some negative impacts on baby’s digestive systems and affect nutrients absorption. The recommendation is to start solids when baby is about 6 months old.

• Not true.
• It’s what’s going on inside that counts. Babies are ready for solid foods when their digestive systems are developed enough to cope. This is usually when baby is around 6 months old. However, every baby is different, so if you think your baby is ready, speak to your doctor about it.

• Not true.
• Breast milk gives the baby everything there is in other milks, and more. Babies should be started on solid foods after 6 months so that they learn how to eat and begin to replenish their iron stores and other nutrients that are not supplied in sufficient amounts by breast milk. Cow’s milk or infant formula will not be necessary as long as the mother continues breastfeeding the baby.

• Not true.
• New research recommends that foods considered highly allergenic, such as peanuts, tree nuts, milk, egg, wheat, soy, fish and shellfish, should be introduced to baby one at a time, after baby reaches his 6 months mark. This is with the exception of whole cow’s milk, which should be avoided until after baby turns 1. Delaying the introduction of these foods might actually increase the risk of a food allergy. However, more caution is needed if you have a family history of allergies. Always speak to baby’s doctor about it to ensure you can safely feed these foods for your baby.

• Not true.
• Research shows that new foods may need to be offered more than 10 times before baby will actually eat it. Whether baby has a true dislike of a certain kind of food can only be determined much later. In the early stages of introducing solids to baby, he will pull all kinds of funny faces as he tries to understand the textures and tastes of these new foods. These funny faces, and even a refusal to open one’s mouth for a feeding, do not necessarily indicate a dislike for a type of food. The idea is to keep trying and not give up.

• Not true.
• Baby juice is not special, nor is it magical. A better option would be to purchase 100% freshly squeezed juice, or to squeeze your own. Make sure store-bought juices do not contain other ingredients such as added sugar and food additives. Don’t give your baby more than 100ml or ½ cup of fruit juice a day. Too much fruit juice will affect your baby’s appetite during mealtimes, and also lead to excessive calorie intake, tooth cavities, diarrhoea and some digestive problems.

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Baby’s First Bites. Petaling Jaya: Mother’s Smart Choice.

Breastfed babies are hardly ever constipated, although they may not have a bowel motion for several days or up to a week. Even then, their poo will usually be soft.

Many babies go red in the face and strain when doing a normal poo. This is not a sign of constipation unless the poo is also hard, dry and crumbly, or like pellets, and the bowel movement seems to cause him pain and discomfort.

If your breastfed baby is constipated, it’s possible he isn’t getting enough breast milk, and you might need to feed him more often.

It may also be that the solids he’s eating are not right for him. Introduce the correct solid food for the age of your baby. Be aware that excessive use of legumes (peas, lentils and so on) and high fibre cereals are not appropriate for young babies.

What to do

• Breastfeed baby more often
• Do not increase your baby’s fibre intake by giving him more wholegrain cereals and fruit, vegetables and water as this approach may NOT be suitable for an infant with constipation. Follow the usual advice regarding introduction of solids for infants less than a year old.
• A gentle tummy massage or a warm bath may help your baby’s muscles to relax, so that he can poo as normal.

Most babies have occasional loose stools. Breastfed babies have looser stools than formula-fed babies.

Diarrhoea is when your baby frequently passes unformed watery stools. If this happens, contact baby’s doctor for advice, especially if baby has passed 6 or more such stools in the past 24 hours, or if he has vomited three times or more in the past 24 hours.

When your baby is suffering from diarrhoea/vomiting, the need for fluids is three times greater than usual.

What to do

• Frequent breastfeeding is required to prevent dehydration and provide nutrients required for recovery from infections.
• Oral rehydration fluids may be needed to replace the electrolytes lost during diarrhoea or vomiting. But speak to baby’s doctor before giving this to your baby.
• Even though your baby’s appetite may be reduced during illness, continue to feed him to ensure he gets the right amount of nutrients, and to enhance recovery.
• If your baby is not vomiting, continue to feed your child, but you may have to give your baby smaller amounts than usual. Encourage your baby to eat soft, varied, appetising and favourite foods that will not further upset the stomach.
• After illness, give food to your baby more often than usual as he needs greater nutrient intake to make up for losses during illness.
• Extra food is needed until the child has regained any weight lost, and is growing well again.

Most fevers are harmless and caused by mild infection. Regardless, you should tell your baby’s doctor about any fever that is higher than 38 degrees Celsius.

When your baby has a fever, the need for fluids is three times greater than usual.

What to do

• Frequent breastfeeding is required to prevent dehydration and provide the nutrients required for recovery from infections.
• Even though your baby’s appetite may be reduced during illness, continue to feed him to ensure he gets the right amount of nutrients, and to enhance recovery.
• Offer baby food if he has the appetite.
• After illness, give food to your baby more often than usual as he needs greater nutrient intake to make up for losses during illness and allow for catch-up growth.
• Extra food is needed until the child has regained any weight lost, and is growing well again.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Baby’s First Bites. Petaling Jaya: Mother’s Smart Choice.

It’s important to pay attention to your baby’s appetite in order to provide optimal nutrition for your baby, and also to avoid overfeeding.

• Signs that baby is hungry:
• Turning to you/getting excited when he sees food or when food is offered
• Fussiness
• Crying
• Putting his hand in his mouth
• Chewing movements

• Signs that your baby may be full:
• Closing mouth as spoon approaches
• Batting away or refusing the spoon
• Show signs of wanting to leave the table or chair
• Becomes distracted by his surroundings

When baby refuses food

• Baby may be full, tired, distracted or sick.
• Always remember that your baby will eat when hungry, and will not starve to death through stubborn food refusal.
• Pay attention to signs when he is full and trust that your baby knows how much food he needs.
• Never force feed your child as this can turn feeding time into a battle time and may even result in overfeeding.

When baby avoids new foods

• Don’t give up if your baby is rejecting new foods. Research shows that a new food needs to be offered up to 10 times, or more, before baby will actually eat it.
• Just getting your child to taste the food will eventually lead them to accepting most foods in the future.

Helping baby accept new foods more easily

• Start with very small portions and offer new food to your child three times during a meal.
• Don’t overreact if your baby refuses. Move on to something you know he likes.
• Try offering the new food at another meal.

When infants are learning to manage new textures, they may gag or cough back food that needs more chewing. This is a natural part of the learning process, and parents should not to panic if it happens. It’s likely that baby just needs more experience to cope easily with the new taste and texture.

However, if an infant gags or coughs frequently after meals, you may want to speak to his doctor about it.

As for spitting up/regurgitation, this seems universal among babies. The good news is that spitting up tends to lessen as babies reach their first birthday.

Reducing the chances of spitting up:

• Burp him regularly
• Avoid overfeeding
• Keep baby upright when you feed him
• Avoid playing with your baby immediately after eating

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Baby’s First Bites. Petaling Jaya: Mother’s Smart Choice.