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.

Nhs advice not bus advice! Autocorrect...

Purees are solids, not liquids. Liquids is water and things like juice, tea. (Neither juice or tea is recommended),

I found weaning quite stressful and it was so easy to just breastfeed that I wish I’d waited longer and enjoyed that more!

Anyone who has done a year 6 science SAT knows liquids aren't solids (I know what you mean though) :p I have definately seen it implied that if weaning before 6 months purees alone should be used rather than proper solids, and one reason to wait for 6 months is to be able to skip purees and go straight to blw?

DSis (paediatrician) says the evidence isn't really clear regarding impact on obesity levels in later life, but that introducing allergens early on is a good thing. She also says that you should NEVER wean before 17 weeks unless under strict supervision from a paediatrician (in some babies with serious issues, early weaning benefits specific to their health problems outweigh the harm).

One thing I hear a lot from blw enthusiasts is that purées are unnatural because blenders are a recent invention. However, chimpanzees and other apes chew food and then transfer to their babies’ mouths, so I imagine there has always been some form of purée. Unless there are some blw chimps.

A lot of mums seem to have blind faith in the latest recommendations or guidance, as if it was evidence based, incontrovertible fact.
Any scientist will tell you that it’s just the current dogma until a better one comes along and challenges it.
The present NHS 6 month guideline is now being challenged as it may increase the risk of severe food allergies to wait that long, especially in babies with eczema.

As PPs have said, the idea was more to push breastfeeding as long as possible, rather than any logic about the timing of solids.
For what it’s worth, my entire generation were weaned earlier than this, and we have a much lower incidence of allergies than today’s children.
A British immunologist attending an international conference was amazed to find his colleagues from countries with early weaning had almost never seen a peanut allergy, for example, whereas it’s rife in the U.K.
Wean your own baby whenever you think they’re ready, but don’t get hung up on guidelines.
I weaned my two at 8 weeks and 9 weeks, as they were lunging towards my plate of mashed potato, so I gave small smears on my finger, that were hoovered with enthusiasm! Both are now nearly 30 years old, fit, no allergies, normal weight.

edgeofheaven - oh God, that made me laugh. It's so true. I think "food before one is just for fun" is a fairly helpful thing to say to stressed-out first-time mums who are crying at mealtimes because their baby won't eat anything. You're not a failed mum if your baby is slow to take to solids or if their appetite varies widely over the course of a few days. However, it seems to get trotted out by all some people as "evidence" that solids don't have any value at all or, worse, that they're some kind of junk food taking up space that should belong to breastmilk, so your baby should be discouraged from doing more than sucking a bit of carrot for a few seconds until their first birthday. Again, if it turns out that that's all your baby does, then don't panic and you haven't failed. But when I was researching weaning when DD was little, I kept coming across women on the more hardline breastfeeding forums who seemed to regard having an eighteen month-old who still wouldn't touch solids as some kind of parenting goal, because breastmilk = pure, other sources of food = impure.

And yeah, at the other end of the scale, you get the parents who think that giving solids at two months means their baby is "advanced".

edge sorry, my post did come off like I thought all weaning at the lower end of the age range was like that and I didn't mean it - I saw these particular babies fed and that's what it looked like, but as you say they're all so different at that age that I completely understand that for some babies of the same age it would be completely different

Sorry, not edge, hugthedugee

Thank goodness for a sensible weaning thread. If I see another mum-scientist advising someone not to wean their clearly ready 25 week-old because ‘one of the signs of readiness is being six months hun’ supported by a meme as incontrovertible evidence of the truth of that statement, I will lose my shit.

I think it depends so much on the baby and the physical development of their body. Rather than adhere to the solid 6 month rule it should be when you feel they're ready, and when they're interested.

DS8 started to pick foods up when he was a little over 5 months; he had no interest in pureed anything and we just rolled with it. He weighed over 10lbs at birth and by 5 months was the size and weight of a toddler, so perhaps he was just ready. The looks on some other parents faces when they realised he'd begun to try solid foods (and I mean very basic fruit and veg foods rather than duck parfait with a red wine jus) was hilarious; one treated me like I'd given him crack, telling everyone at our baby group that her DC wouldn't do x, y and z until the exact moment they reached the right age. Her poor DC always looked so hungry. You do you is my motto when it comes to parenting.

One of the reasons for some lack of empirical evidence is that it is unethical to conduct the kind of trials and double blind studies etc on babies, that would be used on other participants / in other fields. It's the same with medication and pregnant women, which is why relatively little is known about the effects of a lot of medications and women are advised to just not take them.

All you can do is go by the most up to date evidence and guidelines that actually are available. They're guidelines, not laws. So either follow the current guidelines, or don't.

recreationalcalpol I just haven’t joined any of the mum FB groups I was on last time because I got fed up to sharing links to actual evidence (or lack thereof) about weaning age, amber bracelets and vaccinations. I decided to give my blood pressure a break and just not look this time.
For what it’s worth having weaned DS at 5.5 months when he grabbed a bread roll off my plate at a restaurant and started tucking in. I then read up on the various studies and was going to start DD with small tastes including allergenic foods at 4 months. However she is now nearly 5 months and not sitting well at all or showing any interest in our food so I think I’m going to end up leaving it a bit longer. I don’t want to leave it too late though as her aunt has several food intolerances.

If I see another mum-scientist advising someone not to wean their clearly ready 25 week-old because ‘one of the signs of readiness is being six months hun’ supported by a meme as incontrovertible evidence of the truth of that statement, I will lose my shit.

Oh god. When it became apparent that DS would only eat finger food I joined a couple of BLW FB groups, not out of devotion to the principle (though I do find some elements of it convincing, but I may have persuaded myself that to make a virtue out of our necessity!) but for recipe ideas, etc. The UK one is fine, but I have now been chucked out of the US one for questioning (admittedly repeatedly) their evidence-free claim that you should never wean a baby until they sit unaided for the completely arbitrary time of a minute. I saw them telling mothers of 10 month olds who didn't sit unaided that they still shouldn't offer any solids (always with a quite infuriating 'well, we didn't have this problem mama because my little one was always very advanced stupid rosy cheek emoticon but...'). I was also told that it was probably my fault that DS didn't sit independently until around 7 months because I had evidently been neglecting to 'do enough floor time' with him (actually, turned out he just wouldn't sit still enough to sit in that stage where they're basically being balanced in a sitting pose - he only started sitting once he could do it and reach for things at the same time, and he's only sitting for long periods now he can put himself in a sitting position. I can't see what any of that has to do with his capacity/need for solid food)

The European examples listed above are interested because there seems to be a suggested order of how to wean rather than here in the UK where the advice seems to be just give them anything to try (without the salt/sugar/honey etc).

They kept posting the same fucking meme at me as if memes make things automatically true

(Off-topic: waves at Bertie - 'tis Lisa from the miscarriage thread. I use this account on my phone for reasons of technical incompetence. I can't believe how big both our boys are getting now!)

The European examples listed above are interested because there seems to be a suggested order of how to wean rather than here in the UK where the advice seems to be just give them anything to try (without the salt/sugar/honey etc).

Technically the NHS advice is to only give them anything if you start at 6 months - they do say to add in dairy, wheat, nuts and eggs later if you start before then. But, as people have said, the evidence is that this may not be correct - it may be better to have allergens sooner.

There's a 2018 government expert review of the latest research including EAT here www.gov.uk/government/publications/sacn-cot-statement-on-the-introduction-of-peanut-and-hens-egg-into-the-infant-diet , which recommends they stick with the current 6 month guidelines. It's helpful as it picks up some of the weaknesses of the EAT and other studies. Their conclusions were:

'The benefit-risk assessment indicated that there was insufficient evidence to support the existence of a “window of opportunity” for the introduction of peanut before six months of age. Evidence that the introduction of hen’s egg before six months might be beneficial was limited and derived from randomised control trials (RCTs) where participants were not representative of the general population.
33.The benefit-risk assessment indicated that there were insufficient data to demonstrate that the introduction of peanut or hen’s egg into the infant diet before six months of age reduced the risk of developing food allergy to any greater extent than introduction from around six months.
34.There was reasonable evidence to demonstrate that the deliberate exclusion or delayed introduction of peanut or hen’s egg beyond six to twelve months of age may increase the risk of allergy to the same foods. Importantly, once introduced, these foods should continue to be consumed as part of the infant’s usual diet, in order to minimise the risk of allergy to peanut or hen’s egg developing after initial exposure. Families of infants with a history of early-onset eczema or suspected food allergy may wish to seek medical advice before introducing these foods.'

The critical window for peanut must be a bit later because they first realised it was a thing because of the very low levels of peanut allergy in Israel where babies are given peanut 'bamba' as a snack - but my understanding is that they give that at around 7/8 months (it's a finger food so it seems unlikely that most four month olds are eating it). However, what early weaning probably does achieve is making it more likely that babies are actually ingesting significant amounts of food when they hit that age, and so if they're being offered allergens actually eating them.

DD1 declared her interest around 5 months when she started lunging at anything we were eating. We started weaning after the flapjack incident.
My husband had chocolate flapjack in one hand and DD1 dozing on his lap. He was a bit engrossed in the telly and hadn't realised she was awake. She made a sudden lunge for the flapjack and managed to get a good mouthful. She howled when we tried to get it back out of her toothless mouth.
Solids were introduced that week. No allergies so far (21 months) she'll happily eat by herself with minimal supervision.
I'll probably use a similar approach with our next - basically waiting till we get strong cues from the baby.

@NewAccount270219 Is that the Beginners and Beyond group? Their "memes" drive me mad, so much bullshit.

The European examples listed above are interested because there seems to be a suggested order of how to wean rather than here in the UK where the advice seems to be just give them anything to try (without the salt/sugar/honey etc)

In Finland we have quite the list of foods to avoid before 12 months, not just salt, sugar, and honey, foods with high levels of various heavy metals and nitrates and stuff like that, can't remember what exactly because I chucked it out a while ago but I do remember cinnamon being on that list and thought wtf?

had almost never seen a peanut allergy, for example, whereas it’s rife in the U.K.

I would think that’s due to a third factor? I know China for one has a very, very low peanut allergy rate, and that’s apparently because they boil their peanuts which makes them less allergenic somehow (also their immune systems get quite a workout from the environment...)

UK is really not different from other developed countries. Israel is one of the outliers. I would definitely introduce peanut early though, if I had a family history of nut allergies

Yes! Oh god, the memes, the addressing all posters as 'mama', the constant boasting about their babies. I did find the difference between it and the UK group funny though - the Beginners and Beyond group is full of people posting Instagram pictures of perfectly curated plates and posting about how excited they are because their 5.9999 month old is starting soon and is going to do 'so well' at it because they're 'so advanced', the UK one is all 'so, how many times a week can I give fish fingers?' and 'jesus Christ this child eats nothing, what do I do?'