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What should breast-feeding moms eat, drink and avoid? 

The research is overwhelming: Breast-feeding is the ideal way to give infants a healthy start in life, provide them with balanced nutrition, boost their immune systems and create bonds between mother and child.

But which foods and beverages should breast-feeding moms seek out or avoid? This month, Dr. Lewis First, head of pediatrics at Vermont Children’s Hospital at Fletcher Allen Health Care, delivers some advice to help nursing moms go with the flow.

KIDS VT: How much additional food do breast-feeding moms need?

Lewis First: It's really a matter of both the quantity and quality of mom's diet. Many breast-feeding moms don't realize that they need to take in 200 to 500 extra calories per day to meet their energy needs and grow their babies. Food labels are a great way to keep track of those calories.

KVT: Which nutrients are important for nursing moms?

LF: Breast-feeding moms should consume about 1,000 milligrams of calcium per day to keep their own bones healthy and also to help their babies' teeth and bones grow. Obviously, moms can get that from low-fat dairy products, but they can also get it from calcium-supplemented foods such as orange juice and cereal. Moms also need a lot more vitamin D, anywhere from 400 to 1,000 international units (IUs). They can get it from the sun, but I'm more partial to avoiding the sun's rays and getting vitamin D from other sources. Infants should also get a vitamin D supplement. And moms need a good source of carbohydrates and iron. If they're vegetarian, they need to make sure they get enough vitamin B-12.

KVT: How much protein do breast-feeding moms need?

LF: Normally, most women need about 40 to 50 grams per day. When women are breast-feeding, they should take in at least 70 grams daily. This can be through lean meats, fish, poultry, eggs, tofu, beans or peanut butter.

KVT: What about the mercury in fish?

LF: Moms need to keep an eye on their mercury intake. But the good news is, fish contain omega-3s, which are very good at helping develop a baby's brain and eyesight. I recommend one or two servings per week of fish low in mercury. The "fearsome foursome" to avoid are shark, swordfish, king mackerel and tilefish. Moms should also limit their tuna intake. Some low-mercury choices are salmon, whitefish, sardines, anchovies and rainbow trout.

KVT: Is there any truth to the claim that drinking Guinness Stout boosts milk production?

LF: It turns out there is a polysaccharide in certain beers, including Guinness, that actually turns on a hormone called prolactin, which helps moms make more milk. The problem is, there's also alcohol in there, which can inhibit the production of milk and may affect the milk's taste.

KVT: How much alcohol can a breastfeeding mother safely drink?

LF: The Institute of Medicine recommends that a 132-pound woman who is nursing should consume no more than 2.5 ounces of hard liquor, 8 ounces of wine or two 12-ounce beers per day. Ideally, a breast-feeding mother should abstain entirely, though after two hours, it's not clear that any of the alcohol reaches the baby. So, if mom wants to have a drink every now and then, she should time it at least two hours before her next breast-feeding or pumping.

KVT: How about caffeinated drinks?

LF: Nursing mothers should take in no more than 300 milligrams per day of caffeine, which is the amount contained in two 8-ounce cups of coffee.

KVT: Can the mother's diet create a food allergy?

LF: There's a difference between a classic food allergy and a food sensitivity, such as lactose intolerance, which babies almost never have. Moms can reduce the likelihood of food allergies by breast-feeding for the first six months. Only about 2 percent of exclusively breast-fed babies have a food allergy, and it's usually due to a protein in cow's milk coming from the mom's diet. When it occurs, it's not subtle: The baby might experience vomiting, diarrhea, bad skin rash and potentially even difficulty breathing. This is different than the classic food sensitivities to spicy foods, cauliflower, broccoli and certain beans, which can make babies gassy and fussy. Basically, a mom knows her baby best. If she sees her baby not acting like herself or himself, she might think, "What did I eat in the last day?" Then remove that food from her diet and see if it makes a difference.

KVT: Can food sensitivities change over time?

LF: The good news is that, as the gut matures, babies may be able to handle food better than they did earlier in life. So, if mom wants to try that spicy food after a month or so, she certainly can and may find there's no reaction whatsoever.

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