C+G have sent a worrying "update" to Health Care Professionals.

[JollyPirate]

I turned up at work the other day to find the C+G Update leaflet lying around and it was all about weaning. Now this is "research" produced specifically for HCPs but it was shocking. They suggest that although WHO say 6 months is the best age for weaning that there is a window of time in which all babies should be introduced to food (definitely by 6 months according to C+G)
WHO's advice apparently is to ensure continued breastfeeding in the third world where there is less access to food.
They then provide helpful weaning advice. Waking up in the night is not an indication for weaning (true). Babies should be weaned once they are able to sit upright(yes) "or propped up in a stable upright position"

If food is not introduced by 6 months it may have an impact on speech development!
I am a bit shocked actually and have put their article to one side while I consider my response to C+G.

Anyone want to help me write it?

[theyoungvisiter]

I can't help you write this but I am at the leaflet and wanted to bump the thread for you.

Might be worth puttin a link to this thread in breast and bottle (if you haven't already) as I am sure people like tiktok and hunker will be interested.

Tiktok was asking only the other day where people kept hearing about "new research" on the need to wean early due to speech delays. I am now guessing, er, C&G!

[StealthPolarBear]

i can prop up my 4 wo in an upright position - doing it now!!
will keep an eye on this thread

[tiktok]

JollyPirate - as you are an HCP you can call their help line service and ask them for a reference to the research. You can then read it and decide on its quality.

I don't think C&G will have made something up from nothing - but you do need to read the paper. It may not be empirical research, for instance.

[JollyPirate]

Yeah - am being lazy here tiktok. Work has been very busy but was so shocked by what they were saying. They do reference their views but haven't had time to look yet. Was just annoyed as too many HVs use the "6 months is based on third world babies" thing to justify weaning advice from 4 months.

Must try to link to it.

[JollyPirate]

Couldn't find a link but have posted below an extract...

When should weaning start?
Between 4 and 6 months: The DH recommends that weaning should preferably be commenced at six months but no earlier than 17 weeks3. Robust clinical data on the optimal window for weaning indicate that solids should be introduced between four and six months, at a time suited to the individual baby?s development (as advocated by ESPGHAN)4. Solid foods should never be given before 17 weeks, because younger babies are at greater risk of developing coeliac disease or gluten intolerance7, 8. UK recommendations state that weaning should not occur before 17 weeks.

No later than six months: all infants should start taking solids by six months (26 weeks); babies in whom weaning is delayed beyond this often find it difficult to accept lumpy foods9, 10. However, there is no clinical evidence that delaying weaning until six months offers specific clinical benefits3. Data that confirm when is the best time to introduce solids are urgently needed. Six months is an important age when infants begin to learn the side-to-side tongue movement that is the start of the chewing process. By moving food in this manner, infants make the sides of the mouth less sensitive to touch ? a learning point that only occurs if lumpy solids are given.

After the age of one year, if infants have not experienced lumpy solids they are likely to become ?orally defensive?: they become reluctant to have lumps in the mouth and refuse to have any food in the sides of the mouth. Children who are introduced to lumpy solids late, even if purées were introduced at the correct time, are more likely to be fussy about foods and textures in later childhood9-11.

[stripeysox]

JollyPirate - I was incensed when I got the (unsolicited) "Professional Update". I've sent it to Baby Milk Action and asked them for advice on who best to complain to. Not sure complaining to Cow and Gate will make any difference. They'd probably be pleased to know that the information is getting through. For every HV that complains there could be lots of others, possibly skill mix team members who aren't HV's but do baby clinics, development checks etc who are impressed by the article.
If anyone wants to read it they can find it here it's Issue 18 Nutrition and Nurture. Will need to register as a health professional, seems easy enough for non health professionals to register as well.

The article cites the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American Academy of Paediatrics which advocate a "more flexible approach to weaning". It states that weaning should start between 4-6 months.

See below for most annoying (to me) bit of article
...the WHO guidelines provide a global positioning statement on weaning...to ensure infants in the developing world receive the full nutritional, health and bonding benefits of breastfeeding; there is debate on how relevant the recommendations are for the developed world...
..to reduce the risk of coeliac disease or type 1 diabetes gluten should not be given too early (never before 4 months) or too late (after 6 months)...

[tiktok]

I sort of expected them to use ESPGHAN as a back-up - their interpretation is highly questionable, and actually rather twisted. Without actually misquoting ESPGHAN, they give an erroneous impression of what ESPGHAN actually say. You can read ESPGHAN's position paper - it is not research, itself - on line. Just put ESPGHAN complementary feeding into Google.

ESPGHAN is clear - exclusive breastfeeding for 6 mths 'is a desirable goal'. The 'window' they talk about is up to 10 months for lumpy food (not solids themselves). They present evidence for introducing gluten before 7 mths. They support 17 weeks as the minimum age for complementary foods.

Nothing in ESPGHAN's position contradicts current DH guidance for the UK. It is interesting that the message you have taken away is that the window is 4-6 mths. I can't see that in ESPGHAN though they are keen that babies should cease excl bf at 'about 6 mths'. I can't see anything in ESPGHAN about speech development, but there wouldn't be - they are concerned with gastric and nutritional issues only.

You could ask C&G about speech references. I'm not aware of anything that shows babies need solids any earlier than 6 mths for speech development.

[QueenOfFrighteningEveryone]

The article is here but I have just had to register as a HCP on their 'professional' website to see it (I'm not btw, I lied )

Its riddled with crap.

"Risk of choking is less likely to develop if
babies follow the gradual pattern of
liquid/soft mash/lumpier mash/soft finger
foods."

Well, acksherly, IMO, risk of choking is less likely to develop if babies are not given solids until they are physically able to deal/manipulate with them. If you wait until 6m-ish they will be able to just, you know, eat stuff, whereas if you start at 4m you will most likely have to give them semi-liquid food and they may indeed choke if given a carrot stick.

[stripeysox]

Tiktok, sorry didn't make it clear, it was the C&G article that stated weaning should begin between 4-6 months, not ESPGHAN. re asking about speech development, I know I wouldn't get anywhere. I've had a lot of dealings with reps as am the nominated HV who has to see them all . We had a meeting a few years ago when the Trust decided to go for Baby Friendly status, reps had been providing lunches, training sessions etc (which I never went to) a few of us voted to stop all contact but the majority opted to have one person that sees them and decides what info to pass on to the rest of the teams. I was nominated and been trying to get out of it ever since - I'm a Community Practice Teacher and get paid a bit more so get dumped on given extra responsibilities.

[JollyPirate]

The whole thing was utter tripe and sadly tiktok many HVs will have taken away the impression that - hey - 4-6 months as a suggestion is fine. Thankfully the likes of me and stripeysox use our brain and the suspicion that most baby milk companies are out to increase their profits and nothing more.

At 4 months what will a baby eat? Well don't you know it - C+G have a nice line in liquid food.

Am LOL at stripeysox having to see all the reps. Hope they at least buy you lunch.

Alot of the stuff we receive from C+G etc is unsolicited - addressed to "HV, Anywhere Surgery" and some of the "information" is shockingly bad.

[tiktok]

Leonie, you are thinking of Gillian Harris, who is a psychologist specialising in children's eating disorders.

No on doubts the importance of introducing a wide range of textures, including lumps, to babies, and GH's work shows that if this happens too late, it can effect acceptance later. This does not mean they have to be intro'd before 6 mths, it doesn't mean bf cannot continue, and it actually means the pureed gloop babies are offered is not a good thing!

[tiktok]

I know she does, Leonie....but this is because her research was done before the guidance changed, and she is arguing that from the time of weaning (in her sample's case, 4-6 mths) textures should be varied. She's not actually contrasting this with weaning 6 mths plus....none of her sample weaned as 'late' as this. I think I have discussed this before on mumsnet. Her work is irrelevant to weaning age, anyway.

[tiktok]

www.mumsnet.com/Talk?topicid=breast_and_bottle_feeding&threadid=716889-extended-bfing-autism-solid-f ood-introduction#14838037

This is the link to the thread where this was discussed before, and you are there on it, Leonie, and I am explaining to you that GH's work cannot contrast weaning at 4-6 mths with weaning at 6 mths because none of her sample will have weaned later than this.

Have a read and refresh your memory