Can anyone point me to the studies that underpin the advice to not wean before six months?

(34 Posts)
Arrtttiiieee Wed 02-Oct-13 13:30:25

I asked my HV and she said the six months advice is based on one EU study that she believes is flawed. Does anyone know where I can find the evidence base on which the six month advice is based?

CornishYarg Wed 02-Oct-13 13:39:00

The WHO advise waiting till 6 months. I found the paper online a while ago and it quoted the studies on which the advice was based.

tiktok Wed 02-Oct-13 14:11:00

Your HV is wrong - you can send her this link

summaries.cochrane.org/CD003517/optimal-duration-of-exclusive-breastfeeding

You may already know, and she should definitely know, that the Cochrane database is the international standard for evidence-based health and interventions. The review related to the length of time babies are best off on breastmilk alone is based on quality studies.

If she demurs, ask her the study she is thinking of, and look it up yourself.

pookamoo Wed 02-Oct-13 14:15:04

I bet the "study" the HV is talking about was the Daily Mail about a year ago?

kelpeed Wed 02-Oct-13 14:17:08

link

[[http://www.who.int/features/qa/21/en/index.html]

www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/index.html

growth charts in UK and US are based on a narrow part of the population, and formula fed, wheras the WHO growth chart is for babies who were breastfed exclusively for 6 months . the WHO studedaround 40,000 babies from many countries in asia, latin america etc, not just babies of anglo descent.

The growth charts for US and UK babies show massive growth in early months. English midwives And HVs used to fret when my babies were not following pattern of their old and outdated growth charts, (my baby book, despite the babies being born in this millinea (sp??) had a really old chart, based on 1970's baby surveys)

my HV hassled me a lot, made me feel i was doing the wrong thing in my goal to feed till 6 months , escpailly during the 5th month when the babies has some sort of growth spurt and wanted to feed all the time. she intepreted this as that i wasnt peoducing enough ( total bollocks, and showed she her basic lactation knoweldge was rubbish).The babies grew a lot in that 5th month , but she didnt somehow see it like that.

talk to a qualified lacation consultant whose job it is to keep up to date with science-based breastfeeding literature, not literature produced by some EU dairy company.

here are the WHO growth standardsy
www.who.int/childgrowth/standards/en/

more info on infant nutrition

www.who.int/maternal_child_adolescent/documents/infant_feeding/en/index.html

AidanTheRevengeNinja Wed 02-Oct-13 14:27:56

Cochrane reviews (Tiktok's linked the relevant one) are the gold standard of evidence-based medicine/health. They are based on all relevant studies worldwide that meet criteria for inclusion (basically, good quality studies with sound methodology) and you can follow the links in the review to the original studies themselves.

kelpeed Wed 02-Oct-13 14:33:20

sorry about the typos above...blush

your HV can't even quote the name of the so-called flawed survey correctly. if she still quotes it, ask her for an actual copy...she what she come up with.

If she does come up with some document, ask her to confirm who paid for the study.

my HV was really good and caring in many things, but woefully out of date on breastfeeding guidelines.

AidanTheRevengeNinja Wed 02-Oct-13 14:36:23

Incidentally I went to a weaning session and the Health Visitor told me that follow-on formula had arsenic added to it.

I decided to do my own research on health matters after that grin

MummyCoolski Wed 02-Oct-13 14:36:33

I'm loving the love for Cochrane on this thread! Good work, people!

tiktok Wed 02-Oct-13 15:06:21

Kelpeed, happily, all the charts in use in the UK are based on data from breastfed babies, and this has been the case for a few years now.

The old UK charts were different from the US charts, and based on data from UK babies, whose feeding was not differentiated - but they would, largely, have been ff, you are right.

All UK HCPs are supposed to have been trained in this stuff, but it seems some stick to the old ways and old ideas sad

tiktok Wed 02-Oct-13 15:35:35

Aidan, your HV was sort-of-right smile

There was a scare a little while ago in the US, when some toddler milks were found to contain arsenic, because they were sweetened with corn syrup or rice syrup, and it was arsenic in these that was the culprit.

I don't think any UK formulas are sweetened in this way.

AidanTheRevengeNinja Wed 02-Oct-13 15:50:40

Wow, that's quite scary Tiktok - she had a point then! We don't use any formula so I didn't bother to check it out. Although the phrase she used was "they put arsenic into follow-on milk" which made it sound like it was being intentionally added for extra flavour grin

tiktok Wed 02-Oct-13 15:52:03

If you're in the UK, she shouldn't have been saying anything at all about arsenic!

kelpeed Thu 03-Oct-13 00:07:52

It is remarkable that the info HVs use is so out of date though, eg, on arsenic concerns, or 6 months exclusive feeding or whatever.

the 6-month exclusive BFing advice has been around for over ten years now.

Arrtttiiieee Thu 03-Oct-13 09:02:29

Thanks all. That cochrane link is useful.

I'm trying to work out when to put DC3 on to solids. His sibling has coeliacs disease and some studies suggest those at high risk from coeliacs benefit from exposure to gluten before six months. Other studies suggest early weaning can lead to coeliacs. It's all rather confusing!

yetanotherworry Thu 03-Oct-13 14:21:21

Arrtttileee, the australian government have updated their advice based on recent research and now recommend weaning between 22 and 26 weeks. There's quite a few studies now that suggest waiting until 6 months is not optimum but not sure whether this is because people weaning earlier use lower amounts of gluten, or whether this is the optimum time for priming the body. I have heard rumours that advice may be changing in this country at some stage based on the latest research. What does your paediatrician suggest?

tiktok Thu 03-Oct-13 14:56:29

yetanother, you say "There's quite a few studies now that suggest waiting until 6 months is not optimum"....I don't think so!

The only thing I can think of is the editorial discussion document by Fewtrell in 2011, which raised the possibility that for some babies, it would be ok to give solids sooner, and noted that culturally, earlier-than-six-months is normal, and that the public health guidance of 6 mths should be more flexible. In fact the public health guidance already allows for flexibility, with a lower age of 17 weeks for babies who seem to need solids or for parents who for some reason can't bear to hold off a moment longer than necessary smile

www.bmj.com/content/342/bmj.c5955

It is not 'a study'.

The other thing you might have come across is the EAT study, yet to be completed, www.eatstudy.co.uk/, which looks at allergy and age of solids...it won't report its results for ages yet.

So far from 'quite a few', we actually have nothing at present which goes anywhere near overturning the Cochrane review. Even if the EAT study shows that early solids helps prevent allergy and of course it may not, it would still have to be considered in the context of other research supporting 6 mths as the optimum time for exclusive bf.

In the UK, any 'rumours' are spurious. SACN (the govt. committee of experts who look at nutrition and public health) have this under continuous review, as of course they should do, but they are unlikely to change their recommendations with no evidence.

Of course if I have missed the 'quite a few studies', then tell me!

tiktok Thu 03-Oct-13 15:03:48

PS There is a recent study which looks at infants at increased risk of diabetes, and suggests they have solids between 5-6 mths. That has not been generalised out.

Can you send a link to the Australian guidance changes? This has passed me by. Google only gives links to documents stating 'around 6 mths'.

Arrtttiiieee Thu 03-Oct-13 18:52:33

Tiktok, this is the study that made me consider weaning early. It suggests that when Sweden changed its weaning guidance to six months more children developed coeliacs

sciencenordic.com/counter-coeliac-disease-early-glutens

yetanotherworry Thu 03-Oct-13 22:06:19

Sorry but I can't be bothered trawling through loads of papers but there is the norwegian study www.ncbi.nlm.nih.gov/pubmed/23182171 which I think is one of the best studies but there are a few other papers looking at various illnesses and timing of introduction of solids.

The NHMRC is still at draft stages www.ncbi.nlm.nih.gov/pubmed/22472685. Sorry I've been chatting to someone involved in these guidances and hadn't realise that they hadn't been formalised yet.

I think the EAT study will throw up some interesting data and hope that they publish sooner rather than later.

tiktok Thu 03-Oct-13 22:35:03

I'm sorry, yetanother - you are not being clear. You have linked to studies on allergy which is only one aspect of health, albeit an important one. When the 'optimum age' is looked at, it would be essential to look at all aspects of health and growth, which is what the Cochrane review did. I am correct, I think, that there have been no studies that indicate overall that 6 mths is not good guidance.

Thanks for checking on the Australian guidance. You got that wrong, too.

Maybe it will emerge with further studies that public health guidance should change. But we certainly don't have the evidence to do so at present.

yetanotherworry Fri 04-Oct-13 09:32:09

I didn't say we have the evidence at the moment, just that there is a lot of evidence coming from developed countries suggesting that introducing solids at 6 months may not be beneficial to long term health. That paper is just one that I was shown earlier this week. If you do a Pubmed search there are many papers from the last couple of years that indicate optimum time to prevent allergies/gluten intolerance etc is between 4 and 6 months.

tiktok Fri 04-Oct-13 10:14:01

Allergies is an important topic area, but as I explained, yetanother, this is not the whole of child health. There is concern in the developed world about allergy at present; the EAT study I mentioned before is an attempt to see if infant nutrition has an impact on the development of allergy. There are a number of papers in the same topic area.

But any public health guidance needs to look at all aspects - growth, overall nutrition, infections - as well as allergy.

Current guidance should not be overturned lightly - it should be based on decent evidence from a range of studies which look at more than just allergy.

kelpeed Sat 05-Oct-13 15:54:04

interesting

that nordic science link upthread did mention there was an increase use of glutenous flours used in baby porridges, presumably those used at 6 months, which might also be a part of the increase in coeliac disease.

I am sure there must be some reputable (independent) studies that also look not just at the timing of introducing solids but also what foods the babies are being introduced to. i'd guess there has been a shift in babies first foods towards a greater reliance on pre-prepared and/or convienience foods (and so providing a surge of gluten) away from basic food such as mashed root vegetables, rice flour (less gluten cf wheat), apple sauce, bananas etc.

the nordic link is silent on whether the increase of infants with coeliac disease refers to infant coeliac (and when they "outgrew" it). or whether the increase was also for infants which did not outgrow it.

one of the comments in the link also suggested a link with increased use of antibiotics which would disrupt intestinal flora.

kelpeed Sat 05-Oct-13 16:00:44

tiktok are you sufficiently familiar with the EAT study to know if it has provisions covering the use of antibiotics by those babies participating in the study?

kelpeed Sat 05-Oct-13 16:15:07

p.s. my intention is not to wind anyone up about allergies.

i'm with you on looking at the whole picture, growth, overall nutrition, etc and the challenges associated with changing public health messages.

tiktok Sat 05-Oct-13 23:52:46

Sorry, kelpeed, I don't know the details of what they are looking for in the EAT study.

RJandA Tue 08-Oct-13 11:23:25

Tiktok (or anyone else) - the Cochrane review talks about exclusive breastfeeding v mixed feeding - do they mean breastfeeding mixed with formula or breastfeeding mixed with solid foods?

tiktok Tue 08-Oct-13 11:26:57

Without going to the review and reading it (you can do this, they will define their terms for sure), I am pretty sure if they use the term mixed feeding this will include anything but breastmilk, which would mean formula and/or other foods as well.

OxyMoron Tue 08-Oct-13 11:35:09

Does anyone have a link for this study:

"PS There is a recent study which looks at infants at increased risk of diabetes, and suggests they have solids between 5-6 mths. That has not been generalised out"

Thanks smile

tiktok Tue 08-Oct-13 11:45:36

[[http://www.nlm.nih.gov/medlineplus/news/fullstory_138533.html]

tiktok Tue 08-Oct-13 11:46:27

www.nlm.nih.gov/medlineplus/news/fullstory_138533.html

Sorry, that's an actual link now smile

Be aware that this area of research is very contradictory and confusing sad

OxyMoron Tue 08-Oct-13 12:43:51

Thank you Tiktok. I found the abstract here:

archpedi.jamanetwork.com/Mobile/article.aspx?articleid=1707785

Just interested as my dd developed T1D during infancy.

thinkingpositivethoughts Sun 03-Nov-13 20:45:28

RE Coeliac disease - the guidance from Coeliac UK is not to introduce gluten before 6 months and to continue breastfeeding as there is some research suggesting that this may provide additional protection.

Also, please be aware that you cannot 'outgrow' coeliac disease - it is a lifelong auto-immune deficiency and the idea that you grow out like a cows milk allergy is a myth!

https://www.coeliac.org.uk/coeliac-disease/myths-about-coeliac-disease/

www.nytimes.com/2013/02/24/opinion/sunday/what-really-causes-celiac-disease.html?_r=0

https://www.coeliac.org.uk/gluten-free-diet-and-lifestyle/support-for-parents/babies/

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