To wean or not to wean - calling both sides of the fence

[whatstheplanstan]

PLEASE NOTE I AM NOT A HEALTHCARE PROFESSIONAL AND WOULD NEVER ADVISE ANYONE TO CONTRAVENE GOVERNMENT GUIDLINES REGARDING THE WELFARE OF THEIR CHILD. IF YOU ARE CONSIDERING WEANING YOUR CHILD BEFORE THE RECOMMENDED SIX MONTHS PLEASE CONSULT YOUR HEALTH VISITOR.
NHS primary care Q&A service
Cochrane Review
Follow discussions with some of the more dominant characters on mumsnet re weaning, I went away and read the research, being aware that there are many considerations involved in setting global health policies. We agreed that once I'd done some reading a new thread would be started to open the floor to what is a rather hot topic!
To get the ball rolling, here are the key facts I found in my reading:

• the research is based on breastfeeding versus introduction of complementary foods - formula milk is considered a complementary food
  
• the Cochrane review is looking at whether it is safe to promote exclusive breastfeeding to 6 months, and NOT whether it is dangerous to introduce complementary foods before 6 months. These two things are not the same.
  
• Based on the advantages in the developing world of breastfeeding and the need for one global policy, 6 months is recommended. They also note that each 'individual infant should be managed indiidually'
  
• These advantages for developing countries include, reduced risk of infection (antibodies in breastmilk and the fact that it is sterile), poor nutritional quality of complementary foods in these countries and interestingly the benefits of 'lactation amenorrhea' in developing countries (less likely to get pregnant when breastfeeding -but not guaranteed form of birth control!).
  -there is some research into the link between early weaning and allergies. Not enough research has been done yet and eveidence is conflicting (so someone will be able to find a paper telling me its proven!). Breastfeeding (not formula!) does appear to help reduce the risk of allergies, but delayed introduction of some food groups can also cause allergies.
  
• In all countries poor nutrition at 3-6 months can affect growth. It is important that complementary foods do not replace milk (those who saw my thread saw I was concerned about how to make sure my dd still enjoyed her milk - she was turning her nose up at the bottle - turns out she had sore gums from teething and is now back on 30 oz a day). A milk only diet reduces this risk. Poor nutrition is a risk not a certainty, and can be managed (i,e monitoring growth, consultation with health visitor, offering good quality weaning foods)
  
• All agree that complementary feeding should be introduced by six months, to ensure that infants receieve adequate iron and some other vitamins.
  There is a lot of discussion on line about this, but my impression (my health visitor agrees) is that the key driving factor for the WHO policy is the impact on infant mortality in developing countries and not the slight increased risk of allergies.
  Look forward to hearing from you all. I reiterate that I am not recommending that you all go out and wean at 4 months. But I do think its important to read the research and make your own mind up about what the science is behind the policy. Yes it might be a bit better to wait to six months, but is it really so terrible to do it a bit earlier?

[FrannyandZooey]

"Follow discussions with some of the more dominant characters on mumsnet re weaning,"



Can't decide whether to be flattered or offended by that

Good thread stan, will have a read myself and comment later

[MrsBadger]

I agree it 'may not be so terrible to do it a bit earlier' and that any one-size-fits-all global policy has to err on the side of caution. I've also read the Cochrane review with both my science and non-science hats on and broadly agree with your conclusions.

However, the reasons many people give for starting weaning early are even more broad-brushed and unscientific than the research that recommends 6 months.

Parents may think that their baby is too big or, conversely, too small to subsist on milk alone. The amount of emphasis placed on weight as an indicator of health by many professionals and the inappropriate use (and incomplete understanding of) percentile charts does little to reassure parents that it is possible for a child to not be bang on the 50th percentile and still be perfectly healthy.

Of course, the other vital issue is the hope that a baby will sleep better once they start solids - anecdotally I have seen no evidence of this and an awful lot to the contrary - have you seen any evidence-based stuff? (My access to Pubmed is down at the moment - I'm fairly sure there was a BMJ paper)

I also suspect there is also an awful lot of misinterpretation of temporary, growth-spurt type increased feeding as 'Milk is no longer enough for me, bring on the baby pasta!' when all that's really needed is to up their milk intake.

[Chloe55]

That's an interesting post Stan. I'm one of these early weaners who is very much frowned upon on MN (ds was 18 weeks). I had read the advice given by the WHO and am fully aware that to wait to 6mths is beneficial in the sense that a baby runs the risk of allergies and health problems in later life if weaned too early. However, my reasons for weaning earlier were that ds was polishing 9oz of milk 5 times a day and screamed when he saw me eating, trying to steal the food out of my hands.

I had the same problem as you though Stan, ds had become so involved with his solids that he was starting to reject the milk. I decided to hang fire for a week or so and cut back his solids dramatically - he soon increased his milk intake.

He is now 6mths and has 2 meals a day aswell as 3x 9oz bottles and 2x 6oz bottles of milk. He is of average size as far as I can tell from my postnatal group and all seems well in the chloe household

[Chloe55]

Just chuckling about the fact I referred to myself as a weaner

[elliott]

good post stan. I also had a root around the research literature when the 'exclusive bf to six months' cochrane review was first published and I was having to decide about weaning ds2. Totally agree that the review was about potential harm of delayed weaning rather than potential harm of early weaning. I think there isn't a whole lot of evidence out there about the decisions most of us are making about whether to introduce solids at 4 months, 5 months or 6 months and I have to say I don't think it matters a great deal

[Mum2FunkyDude]

I personally think the guidelines are there to cover a broad spectrum population, including third world countries where access to decent weaning foods is not always available.
?Scientifically? speaking the information I got was that baby has to develop a good gut lining and adequate kidney function to deal with solids and this should both be well developed by about 17 weeks unless you have a poorly baby.
You?re in a first world country with educated parents and doctors available at the snap of a finger, NHS on tap, why be insecure about your own abilities to decide when to wean your baby after you?ve gather your information?

[desperateSCOUSEwife]

mum2funky, my ds2 was born ver poorly and could not drink milk without stopping breathing
so I was advised by consultant to start him on solids at a few weeks old
I would never advocate this at all, but it kept my ds alive at that time.

[Chloe55]

How for you desperate, I would never have thought a baby could actually take solids so young.

Your case is a prime example of why sometimes people shouldn't get so uppity about these types of discussions (not that they have on this thread at all though)

[PigeonPie]

My decisions about weaning were based on the research which Gill Rapley did (a basic report can be read here ) and to use the premise that if a baby can pick up and put a piece of food in it's mouth, it can eat it (obviously within reason). I really didn't want to go down the road of faffing about with purees and mush and DS has shown that he's been happy to have been bf till about 24 weeks and now at 9 months is basically eating what I'm eating (roast chicken, roast potatoes, courgette for lunch yesterday) which is a heck of a lot easier for me too!

[Mum2FunkyDude]

desperate I count my blessings everyday for a healthy baby boy. I can only imagine what you had to cope with. It just re-iterate that they are only weaning guidelines. You cannot exactly tell a mother in Ethiopia to do the same as we do in the UK, and as an intelligent person I can make well informed decisions myself hence the need for guidelines only.

[AllieBongo]

When ds was born you were advised to wean at 4mths. I did at 15 weeks. When dd was born it all changed to 6mths? I waited til 17 weeks, she had terrible reflux before, was always hungry (was very big after so much milk!) and to be honest she was much happier... There are all these guidelines, but at the end of the day it is your decision. I have no regrets about being an alleged early weaner, as I'm sure people who have waited til 6months are happy too..

[terramum]

The main reading that swayed me to wait until after 6 months was information about when certain digestive enzyms develop in a babys gut. As far as I am concerned there is little point in introducing solids before these appear as they will not be able to be digested properly. Of course the hard part is knowing when these actually develop, so like others I followed the evidence presented by (amongst other) Gill Rapley and looked for all the signs of readiness before starting (picking up things & placing in his mouth, sitting unaided, showing the ability to chew etc)

[whatstheplanstan]

Thanks for the interest so far, with some good objective discussion, which is exactly what I was hoping for and what mumsnet is all about - its a shame that we don't always get all the details from the health visitors (not to generalise - some are excellent)

[FrannyandZooey]

Stan, I find the OP often sets the tone for the discussion, and yours was a nice calm measured one.

[Alibaldi]

Thanks Stan. I was advised with both mine to wean round 4mnths. Pureed veggies mainly - they hated baby rice . This did not affect their milk consumption. Both were then and still are huge milk drinkers. Also count myself very blessed that they are both healthy and have so far avoided any major childhood illnesses. I will read the Cochrane review with interest.

[divastrop]

when i had ds1 u were advised to wean at 3 months(im showing my age now lol)but i started him at 8 weeks....shock,horror...if only i had changed his milk,as i found when i had ds2 he was draining 9oz bottles every 2-3 hours by 6 weeks old.my hv advised i changed his milk and he went down to 6oz 6 times a day.i still started him on solids at 12 weeks though,as i felt he was ready.dd1 was weaned at 10 weeks(again,shouldve changed her milk),but i was inexperienced to say the least.i did start dd2 (who is now 8 months old)on the odd taste of fruit puree at 4 months but its hard work when they keep moving the goalposts.i cant help feeling that by the time im a grandmother they will be advising mothers to wean no earlier than 3 years....
seriously,though,8 weeks was way too early i think,though none of my children have allergies ds1 is a bit overweight which i know can be a problem with early weaning,but i dont think i coulve managed to wait till after 4 months with any of them

[CantSleepWontSleep]

What an excellent thread Stan. I read much of your original thread, and am pleased that you have now done the research and summarised it so well for the rest of us - saves me a lot of time reading!

Certainly for me you have dispelled a lot of myths. I was adamant that I wanted to wait until 6 months to wean my DD, but I ended up starting around 21 weeks in order to help her silent reflux, and to complete a paed test for milk intolerance. It has helped her no end, but I still felt some guilt for starting earlier than I had intended. I feel much better after reading your summary of the findings.

Was there any mention about increased/decreased risk of obesity and/or diabetes from weaning before 6 months, or did these papers not consider these areas?

[Thell]

Excellent thread Stan!

Pigeonpie - thanks for the link. I recently read Adele Davis' approach to weaning (hardcore 1970s dietician), and she suggested moving straight to proper solids at some point after 6 months, but didn't go into details about how. She was also a bit too hardcore for me - advocating giving liver as a first food for the iron content , obtaining raw milk, fertilised eggs, etc.
DD is now 25 weeks, so I may start giving her some chunks of broccoli and watch on nervously!

[Rosa5]

what a superb thread stan ..Was reading through other weaning threads and feeling guilty as I started weaning dd at 5 1/2 months. However was trying to find more about formula and breast fed babies as my dd is both as i cannot produce enough ( now don't all start saying no such thing as can't produce enough...Please...had bad enough time coping when had to introduce formula as baby was sleeping all the time and not putting on any weight.
My doc at 5 month check ( no HV in Italy) said that formula babies tend to wean earlier and he gave me guidelines on what to use and when and said go with your instinct on when ! She is 2 weeks in and loves her food still very small portions as well as her milk but she still won't sleep through.......

[aitch71]

hey Rosa5,
i just wanted to say 'i hear you' about the not making enough milk. i was the same, but the further away i get from all the trauma the more i realise that being a mum isn't ALL about breastfeeding.
don't have anything helpful to say other than that, sorry, but i'm glad that her weaning is going well.
Fingers crossed she'll sleep through soon.
and thanks for a really interesting thread, stan.

[WellieMum]

Excellent thread Stan, and I broadly agree with your summary.

I think there are 2 main problems with the evidence about weaning:

1. Presumably, whatever the ideal age for weaning is, it will vary between babies in the same way that other milestones vary. However, we still don't understand the process well enough to predict when an individual baby is ready - which is after all the key practical decision.
   
   I think the baby-led weaning system is a good approach but it doesn't address the question of gut maturity or allergies.
   
   The 6-month guideline is a "best guess for everyone" so it's not ideal - it can't possibly be right for everyone. Though it's probably right for more babies than, say, 3 months.
   
   
2. Pretty much every study on the subject is observational, ie looking at when babies were weaned and the state of their health compared to babies weaned earlier or later.
   
   This means that there's a major design flaw: you don't know the reason why a baby was weaned at that age, and any health problems could be a cause or effect of that. eg you have a baby with difficulties swallowing lumpy food who was weaned very late. Did the swallowing difficulties cause the late weaning or the late weaning cause the swallowing difficulties? You can't tell.
   
   --
   Conflict of interest: I weaned dd1 at 6 months and will do the same for dd2, on the basis of the "best guess". I think dd1 could actually have been weaned much later.
   
   I would say my biggest argument with early weaners is that their reasons aren't always very robust, eg getting baby to sleep through the night. If someone feels their child is developmentally ready and is well-informed on the topic, I wouldn't argue with that.

[Rosa5]

Hi Aitch 71 ...Thanks for that I agree re the brestfeeding it was hell at the time talk about feeling a failure and going to the baby clincs and everybody coming in with old wives tales on how to increase. Anyway now we have come to a happy medium and she is growing well and loving her solids as wel as her milk and as for the night last night it was once only so getting better ...famous last words..

[samnbabes]

Great thread - thanks! Having just weaned dd2 at 5 months, was feeling guilty having managed to get to 6 months exclusive b/f with ds1 ... was sure she was ready/getting all the signals, but still felt like a bad mum - helpful to see such balenced/researched views.

Useful to read other people's experience on responses to milk too - ds1 was always (& remains) v keen, whilst dd is trying to live on babyrice alone & I'm simultaneously trying to shift some feeds over to bottle, so not great timing - this was a good kick up the jacksie (sp??) for me to refocus on the milkies...

[ruthydd]

Thanks for this interested thread. I read the WHO report a few months back and was disappointed by its focus on whether there are any negatives of waiting until 6 months rather than are there any negatives of weaning earlier i.e. your second bullet.

What I find most frustrating about the whole debate is the list of "signs" that your baby is ready. In my opinion, a 4-month old watching you eat is no more a sign that he needs solids than him watching you drink a glass of wine meaning that he might be ready for alcohol.

p.s. Stan - love your disclaimer. Might add my own to all future posts along the lines of
"The views expressed are not always carefully considered and may be typed with one hand, so please take no offence because none is intended...I just have an odd sense of humour ..etc ... etc.."