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Does delaying weaning help prevent allergies?

(19 Posts)
DaisySteiner Thu 21-Aug-08 10:19:32

Have recently been chatting with a friend who is a senior dietician and nutrionist for the NHS about when solids should be introduced.

She was saying that the WHO document on infant feeding doesn't say anything about delaying introduction of solids to 6 months preventing allergies, only about reducing infectious diseases. Unfortunately I can't seem to get hold of this document online to read it myself.

She was also saying that anecdotally the other clinical paedeatric dieticians that she works with have been seeing an increase in the number of referrals of babies who are having problems with weaning and in particular eating lumps, after delaying solids to 6 months. Her opinion is that parents need to be told that it's fine to wait til 6 months but that they really need to go very quickly after this and make sure that babies are given lumps and finger foods quickly (BLW ideal apparently)

I've since been having a look (fairly briefly, I admit) for actual research on how introducing solids after 6 months can decrease the risk of allergies. Everything seems to be saying that below 4 months substantially increases the risk and delaying past 7 months may also increase the risk (of coealiac disease at least)

Is there any actual research looking at post-6 months weaning compared to 4-6 months - I don't mean opinion pieces from Kellymom et al(great as they can be), I mean actual published research.

TIA

kms123 Thu 21-Aug-08 10:23:13

I'm really interested in this too to get actual research articles having looked up and found little. My baby is 4 months and may see from another post that I have felt pushed to wean now.

Ledodgy Thu 21-Aug-08 10:30:12

I'm not sure about the allergy thing but I definately agree with the lump thing.

I started weaning ds2 at 6.5 months and introduced the texture that you would expect a 6 month old to be able to cope with such as finger foods and lumpy foods. He is now 7.5 months and has coped very well without purees at all and i'm not doing BLW a such I am doing a mixture of spoon feeding and finger foods. He will eat spaghetti bolognaise lumps and all and a variety of other stuff. I think the problem with lumps come when some mothers give them only fully liquidised food at 6 months instead of leaving some texture in there to encourage chewing.

twentypence Thu 21-Aug-08 10:53:23

Ds ate stuff all until 8 months because he was allergic to all first foods and so we had to keep going back to bfing.

He now eats everything he can eat in vast quantities.

He isn't keen on mixed textures - but neither is my mum who was weaned at around 8 weeks or something ridiculous.

LittleMyDancingForJoy Thu 21-Aug-08 10:58:40

lots of info and links on kellymom here

DaisySteiner Thu 21-Aug-08 11:10:35

Thanks LMDFJ, have skimmed through these, but many of the links are brokedn and the rest are mostly unreferenced opinion pieces. I'm looking for published research looking at introduction of solids 4-6 months versus after 6 months.

LittleMyDancingForJoy Thu 21-Aug-08 11:17:20

sorry, didn't try the links - that suprises me, kellymom is normally very reliable.

oh well.

VictorianSqualor Thu 21-Aug-08 11:33:25

There are some links on this .pdf.

cmotdibbler Thu 21-Aug-08 11:33:44

The WHO publications are all here.

The essential problem is that weaning under 4 months definatly causes allergy problems. Weaning at 6 months brings that down. Gut sealing occurs somewhere in between for an individual child, but no one knows when. As breastfeeding to 6 months provides a child with all the nutrition it needs, and protects it against a whole host of infections (even in this country), that is the best thing to recommend for the population as a whole. WHO recommend the introdction of lumpy food at weaning, as do the DoH in their weaning leaflet.

The thing about coeliac disease and the Belarus allergy study is that they didn't control for mums of allergenic families tending to wean/exclude major allergens till later, which skews the data.

We will never have a definitive answer on this as no one would be willing to enter a randomised trial where you were told at birth that you were to formula feed for 4 months, then wean, or breastfeed for 6 months then wean or combinations of this.

VictorianSqualor Thu 21-Aug-08 11:37:41

Here is a paper on it.

In fact if you google

Reviews of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic, Oral Motor and Maternal Reproductive and Lactational Development. April 2001

You can find quite a lot on it.

DaisySteiner Thu 21-Aug-08 14:57:28

Thanks all, will have a read.

DaisySteiner Thu 21-Aug-08 19:49:48

Can only read the abstract of that paper VS, so it's difficult really to critique. I did try using the same search criteria as them though, (haven't ploughed through everything admittedly, but have looked at lots of stuff) and could only find one paper that supported delaying weaning to >6 months and that was half-hearted. I did find plenty of research which concluded that delaying weaning made no difference or even possibly increased the risk of allergies.

"The thing about coeliac disease and the Belarus allergy study is that they didn't control for mums of allergenic families tending to wean/exclude major allergens till later, which skews the data." It would also suggest that delaying introduction of solids in allergenic families is of limited benefit? It certainly doesn't prove that delaying to 6 months is beneficial IMO.

Managed to read most of the WHO document - it barely mentions allergies other than discussing a few pieces of research and none of them appeared very convincing in support of delaying solids. Its conclusion doesn't even mention allergies and appears to be saying that there are few risks with delaying solids to six months, so why not.

"The essential problem is that weaning under 4 months definatly causes allergy problems. Weaning at 6 months brings that down." - but where is the evidence for this?

"In fact if you google

Reviews of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic, Oral Motor and Maternal Reproductive and Lactational Development. April 2001 You can find quite a lot on it." - Well Google brought up lots of links but none of them were to the actual research that I'm looking for.

Can I just say that I've come to this from the perspective of believing that delaying solids to 6 months is beneficial in preventing allergies and wanting to prove it to myself. I haven't been able to do this so far, what am I missing?!

cmotdibbler Thu 21-Aug-08 21:10:43

The AAP paper has good references : here

If you use Pubmed and search 'breastfeeding allergy' you get a lot more too

DaisySteiner Thu 21-Aug-08 21:36:18

It's Pubmed that I've been using.

The paper that you've linked to concludes "Although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow milk protein formula or human milk."

So again, no evidence that waiting until 6 months is better than between 4-6 months.

Have found one (!) paper that says "The risk of allergic diseases, eczema, wheeze and ear infection in particular, were lower in children with prolonged breast feeding (>6 months) than in those with short-term breast feeding duration (<6 months)." It's not clear though whether this means any breast milk or exclusive breast-feeding with no solids or formula.

The Cochrane review on exclusive breastfeeding to 6 months (which is what the WHO document is based on I think) says "No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus."

Still feeling unconvinced hmm

morocco Thu 21-Aug-08 21:41:46

am with cmotdibbler on this
I'm not sure you're going to find the kind of definitive answer you are looking for tbh, it's all about a 4-6 month window

milkmummy1 Mon 25-Aug-08 17:47:57

I followed the guidelines and BF exclusive for 6 months and weaned at 6 months. So far DS has showed great health etc (though obvioulsy still early days) and whilst i think i definitely weaned at the right time, i do think i pureed for too long as he is gonig through a stage now (at 19 months) of spitting out lumps like veg and fruit (and throwing it on the floor) but eating it if it is pureed. he is fine with finger foods like toast and pasta. so i sometimes think i went wrong somewhere like not introducing foods early enough and taking the weaning too slowly but hopefully it is just a stage he is going through with the veg etc. sorry this probably isnt very helfpul to your orginial post but i wonder if anyone else has found this prob?

tiktok Tue 26-Aug-08 09:40:13

(milkmummy - better to start a new thread on this. It's a good question)

Daisy - the evidence on allergies being reduced if you introduce solids at 6 mths as opposed to 4 mths is thin - and as has been said, we are not really in a position to glean definitive data. Certainly, solid food before 4 mths has been shown in many studies to have a connection with allergy/atopy/serious metabolic conditions.

There's a common sense view that not being in a hurry to intro solid food until the baby is capable of holding, licking, tasting (ie until he does not actually need purees) follows what the baby's own 'system' is geared to cope with - anyone can get purees down a young baby just by shovelling it in, and the baby is not really in control. Babies are not usually capable of holding, licking and tasting new foods until - guess what? - somewhere around 6 mths. Very few babies of 4 mths show interest in doing this. This is a powerful clue to when babies reach this stage of development.

There are no papers which reveal any benefits to solids before 6 mths (except in individual, special cases where an individual baby might need special treatment) and no papers which show harm if solids are not given until then. The good evidence is on infections, as you say - but to me, that's quite a powerful bit of evidence. Sure, in the UK babies are not going to die of an infection, but even a mild tummy bug or an ear or chest infection is miserable (from memory, these are the infections cited in the research). It means a trip to the doc, possibly medication, hassle, pain.

The PubMed listed study you quote: you have misinterpreted the conclusion. It says there is no evidence that solids after 4-6 mths, ie after 6 mths is beneficial.

There is no magic date for all babies. But when it comes to policies,it makes sense for parents to know there is no harm in a milk-only diet for 6 mths for most babies, and considerable evidence of benefits. In addition, they should be encouraged to offer their babies ordinary food, for the baby to explore and discover. This makes developmental sense, too, as the baby's skills in understanding the link between his eyes, his tastebuds, his fingers and hands and his mouth, are all supported, in a way which can't be replicated by spooning in a puree which he doesn't really see and doesn't handle.

DaisySteiner Thu 28-Aug-08 13:47:03

Sorry, didn't see your reply until now Tiktok. I'm not really arguing that the guidelines shouldn't be exclusive breast-feeding until 6 months. Clearly there are no major medical risks with this advice and some benefits with reduction in infections, delayed resumption on menses etc.

My bugbear is that whenever anyone mentions weaning before 6 months (on MN at least) somebody jumps on them and says that it will increase the risk of their baby having allergies in later life, when there is no evidence to support this. I suppose I'm being a bit pedantic, but parents need to make decisions for themselves on accurate information.

Infections can be miserable, but so can repeated night-wakings, frequent feeding, whingy babies etc and anecdotally at least solids may help with this. It is not for me to tell parents which is more important.

tiktok Thu 28-Aug-08 18:55:14

Daisy - the evidence we have on early solids and night waking shows that at best, solids have no effect and at worst, they make the night feeding more frequent. Of course individuals may have a diff. experience but there is no need to rely on individual anecdotes when we have evidence to show otherwise.

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