Breastfeeding while fasting

Adherence to the Islamic religion requires fasting from sunrise to sunset throughout the month of Ramadan. Therefore, the duration of a fast can vary from 12–16 hours, depending on whether Ramadan falls in the summer or winter months. It is also an obligation for practising Muslims, and missed fasts must be made up for by fasting at a later date, or fidyah. Therefore, most practising Muslim mums prefer to fast.

A woman who has fasted since she was old enough to do so is capable of making the decision whether to fast. If she feels fit on the day, she can decide to fast. And if she decided to fast and she or baby’s health are affected she can pause fasting until they recover and resume as she sees fit. As a form of religious respect, non-Muslims should refrain from dissuading a Muslim mum from fasting.

Yom Kippur, the Jewish Day of Atonement, requires an almost 25-hour fast. Jewish mothers who are breastfeeding can consult a Rabbi or the Nishmat for more information about fasting for Yom Kippur.

How does fasting affect breast milk?

Milk supply

While severe dehydration can decrease milk supply, breastfeeding research tells us that short-term fasting does not decrease milk supply ¹⁾, ²⁾.

Nutrient content of breastmilk

Zimmerman et al ³⁾ studied the breastmilk of 48 healthy mothers who were exclusively breastfeeding a baby aged between 1 and 6 months and who fasted for close to 25 hours during Yom Kippur. This study found that fasting resulted in some short-term changes to breastmilk composition. The author of this study indicated that, ‘The practical significance of these changes should be seen within the context that thousands of babies undergo this exposure yearly without reported clinical effects’. Breastfeeding mothers can help ensure their baby remains well hydrated by continuing to breastfeed as per normal and monitoring their baby’s output (poops and urine). If the mother has any concerns about her ability to fast, she should seek medical advice.

Bener et al ⁴⁾ also studied the breastmilk of 26 healthy mothers between the second and fourth weeks of Ramadan and 2 weeks after the end of Ramadan. This study found no significant differences in the content of major nutrients of breastmilk taken during and after Ramadan.

Effect on baby

Khoshdel et al ⁵⁾ studied the effect maternal fasting during Ramadan had on the growth of exclusively breastfed babies aged 15 days – 6 months. The mothers of 36 of these babies fasted throughout Ramadan and 80 mothers did not fast. The babies’ growth was evaluated twice during Ramadan, 3 times in the second month and bimonthly in the next 4 months. This study found no significant differences in the growth of the babies in either group. This study concluded that Ramadan fasting by breastfeeding mothers does not adversely affect the growth of exclusively breastfed babies at least in the short-term.

Likewise, Haratipour et al ⁶⁾ studied the growth of 55 healthy exclusively breastfed babies aged 1–6 months. Of the 55 babies, 20 of their mothers fasted throughout Ramadan and 35 of their mothers did not. The babies’ growth was evaluated twice in Ramadan and four times in the first, second and third months after Ramadan. This study concluded that Ramadan fasting by breastfeeding mothers did not adversely affect the growth of breastfed babies at least in the short term.

If a mother does not drink fluids for a day, her baby would generally breastfeed as usual the day of the fast, but would often breastfeed more often the next day or two ⁷⁾.

Effect on mother

Healthy mothers are likely to cope well with short-term fasting. However, it is always a good idea to seek medical advice prior to fasting.

Zimmerman et al ⁸⁾ recommend for breastfeeding mothers to ‘increase their fluid intake during the 2 days prior to the fast so they begin the fast as well hydrated as possible’. They also recommend for breastfeeding mothers to ‘decrease their activities and heat exposure as much as possible during the fast’.

How do I know my baby is getting enough breast milk?

You know your baby is getting enough breastmilk if she:

• Is breastfeeding well and frequently
• Has plenty of pale, wet nappies (at least 5 disposable or 6 cloth nappies in 24 hours)
• Has 3 or more soft bowel motions a day (babies older than around 6 weeks may have less than this)
• Is gaining weight and has some periods in which she seems reasonably alert, active and happy.

Crying doesn’t always mean that your baby is hungry. For about the first month, babies usually breastfeed every 2 to 3 hours. As they get older, their bellies are able to hold more and they nurse less often.

Watch your baby for signs that she’s full – like turning her head away or falling asleep. If your baby sucks on her fingers or moves her mouth like she’s eating, it doesn’t always mean she’s hungry – babies do these things to comfort themselves.

In the first few days of life, if your baby is frequently wanting to feed and crying, she may truly be having difficulty with breastfeeding. If you are concerned that your baby isn’t eating enough, talk to your baby’s doctor.

A newborn’s nappies

Wide variation exists in what is seen in a newborn’s nappies. The following gives a general guide as to what might be seen.

The first bowel motions a baby has are black and sticky. This is from the meconium present in the baby’s digestive tract before birth. By day 2, the bowel motions should be softer but still dark in color. Over the next few days, the bowel motions change to a greenish-brown and then to a mustard-yellow. As the color changes they become less sticky and larger in volume.

A baby should have at least 1 wet nappy on day one, at least 2 on day two, at least 3 on day three, at least 4 on day four and at least 5 on day five. From day 5 onwards, the information above is relevant.

Over the first few days, salts of uric acid in your baby’s urine may leave a rusty, orange-red stain on the nappy. This is normal during this time. If you see this after day 4, consult a doctor.

Daily diapers

A newborn’s diaper is a good indicator of whether he or she is getting enough to eat. In the first few days after birth, a baby should have 2 to 3 wet diapers each day. After the first 4 to 5 days, a baby should have at least 5 to 6 wet diapers a day. Stool frequency is more variable and depends whether your baby is breast or formula fed.

Growth charts

During regular health check-ups, your pediatrician will check your baby’s weight and plot it on a growth chart. Your baby’s progress on the growth chart is one way to tell whether or not he or she is getting enough food. Babies who stay in healthy growth percentile ranges are probably getting a healthy amount of food during feedings.

How do I know when my baby is hungry?

For babies born prematurely or with certain medical conditions, scheduled feedings advised by your pediatrician are best. But for most healthy, full-term infants, parents can look to their baby rather than the clock for hunger cues. This is called feeding on demand, or responsive feeding.

Hunger cues

A hungry baby often will cry. But it’s best to watch for hunger cues before the baby starts crying, which is a late sign of hunger and can make it hard for them to settle down and eat.

Other typical hunger cues include:

• Licking lips
• Sticking tongue out
• Rooting (moving jaw and mouth or head in search of breast)
• Putting his/her hand to mouth repeatedly
• Opening her mouth
• Fussiness
• Sucking on everything around

It is important to realize, however, that every time your baby cries or sucks it is not necessarily because he or she is hungry. Babies suck not only for hunger, but also for comfort; it can be hard at first for parents to tell the difference. Sometimes, your baby just needs to be cuddled or changed.

How often should I breastfeed?

Your breasts make milk in response to your baby’s sucking. The more milk the baby takes, the more milk you make.

You are more likely to establish a good supply of milk if you:

• Breastfeed frequently, whenever your baby fusses or seems hungry.
• Let baby finish the first breast. You will know this because the baby will stop sucking and swallowing and will let go of the breast. Then offer the second breast.
• Breastfeed your baby at night. This also helps prevent your breasts becoming too full and uncomfortable.
• Many young babies feed between 8-12 times in 24 hours.
• Avoid giving complementary bottles (‘comps’) unless medically necessary, as these will reduce your baby’s needs to suck at the breast and so reduce your supply.

General Guidelines for Baby Feeding:

It is important to remember all babies are different―some like to snack more often, and others drink more at one time and go longer between feedings. However, most babies will drink more and go longer between feedings as they get bigger and their tummies can hold more milk:

• Most newborns eat every 2 to 3 hours, or 8 to 12 times every 24 hours. Babies might only take in half ounce per feeding for the first day or two of life, but after that will usually drink 1 to 2 ounces at each feeding. This amount increases to 2 to 3 ounces by 2 weeks of age.
• At about 2 months of age, babies usually take 4 to 5 ounces per feeding every 3 to 4 hours.
• At 4 months, babies usually take 4 to 6 ounces per feeding.
• At 6 months, babies may be taking up to 8 ounces every 4 to 5 hours.

Most babies will increase the amount of formula they drink by an average of 1 ounce each month before leveling off at about 7 to 8 ounces per feeding. Solid foods should be started at about 6 months old.