To expect weaning guidelines to be evidence-based?

[xtinak]

Well, perhaps they are evidence based but I'm having a hard time locating the evidence! Please help. My daughter is now 4 months and I am still so confused.



I know the NHS guideline is based on the WHO guidance, which is to wait until 6 months, or rather to exclusively bf for 6 months before introducing complementary foods.I get that it's a guideline. It seems unlikely that there wouldn't be differences between what exactly is best across, for example, countries, breast/bottle/mixed fed babies and of course for individual babies, but still the WHO guidance has to offer an answer that will do the whole world.



Thing is, I still cannot see a strong argument for the difference between 4 and 6 months when it comes to the UK. For example, the fact that ebf longer might possibly delay the return of my period seems beyond irrelevant!When it comes to increased infection risk, the increased risk seems quite marginal, the types of infection non-serious, and the whole thing is complicated by the fact that formula is defined as a complementary food, so sometimes such infection may be associated with introducing formula rather than solids. And we know that formula introduces this small extra risk and most people accept this small risk quite happily!There doesn't seem to be an adverse effect on weight gain of solids at 4 months, despite the logic of milk being more nutritious than solids.




Often on MN I see an argument is presented that the gut may still be 'open' at 4 months. I had assumed this was true as it is so often cited, but it doesn't seem to be!? I've been searching for a relevant study to no avail and the Science of Mom blog discusses it here:

scienceofmom.com/2016/05/03/whats-up-with-the-virgin-gut-do-babies-really-have-an-open-gut-until-6-months-of-age/






The NHS also gives a mysterious list of foods not to introduce before 6 months if you do start solids early. Fair dos on honey - no one wants botulism. But this list also includes for example, dairy. But why? A majority of babies will have already encountered dairy in formula. Or gluten. Why? Where is the evidence that gluten at 4 months is bad but at 6 months is ok? I can't find it.I'm actually going mad trying to get to the bottom of it all. And if you can show me with science that some of what I've asserted above is false I will be all to happy to learn. Please someone rescue my sanity.

[BeanBag7]

Read a properly referenced book rather than online articles.

I read "Why starting solids matters" by Amy Brown.
It's not trying to sell you anything, or get you to buy into some "method" of weaning. It's not emotive. It's fact based and evidence based, with references to scientific journals.

[xtinak]

I will look it up @BeanBag7 thank you!

In fairness to me mostly I am looking at things like this journals.lww.com/jpgn/Pages/ArticleViewer.aspx?year=2017&issue=01000&article=00021&type=Fulltext

[BeanBag7]

@xtinak oh that's good, I think people should be encouraged to read source material more, rather than the simplified version on a website or newspaper. It's unfortunate that the papers are usually so dense and hard to read for many. Also it's so difficult to wade through hundreds of possibly irrelevant papers trying to find one which gives you the information you want, which is why a book can help you narrow it down.

[parietal]

try searching on google scholar.

one big problem is, this is a VERY hard area to get good evidence. you can't do a randomised controlled trial of where you allocate 500 babies to be breastfed to 6 months and another 500 to be given solids earlier, and then follow them up for years to see what happens. It is neither ethical nor practical. So most of the evidence is from correlational studies, which always have a bunch of caveats.

my not-very-evidence-based opinion is that it doesn't matter. Do what works for you & your baby and it will all be fine.

[pastabest]

I don't have any evidence based answers OP but as the mother of two children that have a coeliac parent and two coeliac grandparents (one on each side) it's an answer I've tried to find myself.

I came to the conclusion with a very sensible health visitor that the advice not to wean at all before 17/18 weeks was reasonably sound, that generally early exposure to potential allergens sometime after 18 weeks is increasingly being found to be ok rather than bad, and then after that it came down to mothers instinct and the readiness of the baby.

Both of mine have started extremely gentle weaning sometime between 5-6 months and so far so good.

[Valkarie]

Sadly most advice you find for babies seems to be non-evidence based and usually contradictory to the next advice giver. Went with 6 months as that is what the nhs says and it's when babies can start eating more than just puree. I figured we didn't evolve with blenders, so needing to make food that fine for a baby to eat doesn't reflect what we would be able to do in the wild. No science to back up that opinion though! I also think that there is evidence emerging that suggests early introduction to common allergens might be a good idea, but my kids were too old by the time that came out.

[SausageSimon]

I've personally never heard of any sort of negative reaction to weaning earlier than 6 months.

Unbelievably, someone I know (and dislike for many reasons including this) weaned her 3 month old using one of those chocolate dairy milk yogurts as her first ever food!

I started DS just after 4 months and we've had no issues what so ever. He's as healthy as can be. Minus a bean allergy, but he never had beans as a baby so maybe I should've given him some! Who knows

[Triangled]

Isn't it partly related to when they can sit up unaided? If they can't sit up they are more at risk of choking...and I guess 6 months is an average age of babies being able to sit?

[NailsNeedDoing]

Thing is, they can't get evidence until they've tried something out for a while, and then waited a few decades to see what happens long term.

My dc are older teenagers, and advice was still to start solids at 16 weeks when they were babies. We won't know what difference those extra two months might make to adult health for ages yet.

[DrWhy]

There was a big new study going on about two years ago - the EAT (early allergy testing?) study that seemed to show that introducing potential allergens like wheat and dairy before 6 months actually reduced the incidence of allergies but the outcomes don’t seem to have made it to the NHS yet.

[Dreamingofkfc]

Tbh weaning is messy, time consuming and just gives you another thing to do. I wouldn't start before 6 months

[xtinak]

@Triangled yes the sitting up part does seem to make sense. On the other hand, the current NHS wording is "stay in a sitting position and hold their head steady" and I expect that many babies could do this in a high chair sooner. Also it isn't uncommon at all for sitting unaided to take longer than 6 months and there seem to be good arguments to not let weaning go much later than 6 months, relating to allergies and body nutrient stores. So this still isn't quite cut and dry.

[dementedpixie]

The EAT study introduced allergens alongside breastfeeding. They are unlikely to change guidelines until the same results are achieved with formula fed babies too

[DrWhy]

Got what EAT stands for totallybwrong, it’s ‘enquiring about tolerance’ www.food.gov.uk/research/food-allergy-and-intolerance-research/eat-study-early-introduction-of-allergenic-foods-to-induce-tolerance

[DrWhy]

Thanks dementedpixie I hadn’t considered that angle. That is a better explanation than my HV could give as to why it hadn’t changed!

[dementedpixie]

I started weaning dd at 17 weeks (guidance at the time) and found it stressful and messy. In hindsight she wasn't ready at that age. I waited until 23 weeks with ds and it was easier and less stressful

[xtinak]

@Dreamingofkfc that's a fair point too, but I'm going back to work at 6 months and so for my own practical reasons getting a bit of a jump on the weaning might still be handy. Wouldn't want to proceed early if there really is evidence of potential harm obviously.

[Hugtheduggee]

Even if 'average' sitting age is 6m, there is such variation, that it wouldn't make sense for weaning guidelines to be based on age if sitting is important.

If doing it by independent sitting, I'd have started weaning at 3m, other friends wouldnt have until 7-8m. It doesnt make sense.

As it was, I started with small amounts at 4m after reading into EAT and LEAP studies and it went fine, my child has no allergies or issues with food bar the usual toddler fussyness later. Some people were extremely nasty to me about 'early' weaning though.

[xtinak]

@DrWhy @dementedpixie thanks for that and the link does seem to suggest that it wasn't always possible to get enough of the allergen consumed anyway - I'm imagining eggs ending up on the floor!

[StateofIndependance]

See also: baby led weaning. It may sound sensible in some ways but it implies a correlation between physical development and nutritional need which just does not exist. Nutritional needs are the same regardless of the development of fine motor skills and chewing ability. It’s just not evidence based and the pushing of it (not by the NHS but many books etc) has led many people to believe that babies don’t actually need food until over the age of 1.

[BluishMoon]

I think do what works for you, assuming you're sensible obviously. Mine were started at 16, 18 and 21 weeks.

I know a lot of pediatricians through work and one of them said to me that most of them were unhappy when the guidelines were changed to 6 months

[MyDcAreMarvel]

I have premature twins and their consultant advices me to wean them at 16 weeks, 10 weeks adjusted due to severe reflux. This was five years ago.

[Pleasegodgotosleep]

We've just found out that our lg has dairy allergy . She's been ill without explanation for months, we started weaning at 6 mths and it became obvious (hives etc) that it's an allergy her previous symptoms were caused by dairy in my breast milk. If we'd started weaning earlier we would have known earlier BUT she could have been much more seriously ill to have a bigger reaction when an even younger baby

[NewAccount270219]

I agree with you that it's really hard to find good evidence. It seems that quite a lot of the reason that the NHS advises six months is because people are so keen to wean 'early' that if you say 4-6 months you'll start getting significant numbers of three months old having solids again - which I sort of get the logic of, but also think is tremendously patronising. It's the medical equivalent of telling people dinner starts at 7.30 when it's really 8 so that they're not late!

Fwiw I was all set to wean at 5 months on the model of the EAT study, DS made it clear he wasn't on board and I didn't want to push it, especially as I was still a bit conflicted about whether to do it anyway, at six months we finally figured out he wanted to self-feed and hated being spoon fed. He set about doing this with great enthusiasm but less competence and didn't really eat anything much until around 7.5 months. I stressed over this all tremendously. He's nearly 9 months now and it all already seems like a storm in a teacup and I regret giving it so much headspace.

[NewAccount270219]

People are weird about weaning, though. In my mum's group we had both the people who made their disgust about anyone weaning before six months on the dot absolutely clear, as if some magic klaxon goes off in the gut at exactly the half birthday, and we also had the people who were convinced that weaning at 16 weeks showed that their baby was very advanced because it showed that they were ready for real food (by which they meant puree, delivered to a semi-reclined baby who therefore could barely spit it out if they chose...)